Question about sleep study report

[yardbird]

I have the patient information release form from the hospital where my sleep study was done (because I asked for a copy of my sleep study)

Well.... in the fine print it says that for hospitals and doctors it's free, but anyone else pays 75 cents PER PAGE!
I have no idea how big the record is because of course they don't tell you that. Can anyone who has done this tell me if there's a summary page that's standard? What should I be asking for specifically? Or should I make arrangements to GO to the hospital and go through it and just request copies of the pages that have meaningful data?

I have no idea what the entire record comprises.

Thanks

[Ron]

Yardbird,

The report I received was 8 pages. My advice, pay the 75 cents per page and request the "full" sleep study report. It has valuable information and you will most likely need it in the future if you have a new doctor, your DME/Health insurer may require a copy of it for medical equipment prescriptions, and above all else it will serve as your "baseline" if you ever have another sleep study performed. You need a copy of it.

[rested gal]

Yardbird, I second what Ron said - get your full report.

The link below shows the information I received in two full reports from two nights of PSG studies -- wired up just to collect data with no cpap being used on the diagnostic first night. Second night was the titration night -- sleep tech trying different pressures with me wired up again and using the lab's cpap machine. (I added my own notes. ) The third night was an extra, using my own autopap...not the usual routine for a sleep study.

Those reports were emailed to me, so I don't know how many pages there would have been had it been printed out at the lab. Maybe eight pages or so per night, as Ron mentioned.

What you don't have to worry about is that asking for the "full report" would mean any lab would print out hundreds of pages of the PSG raw data -- the minute by minute epochs of your hours of sleep that night. They aren't gonna print hundreds of raw data pages and trundle it out to you in a wheelbarrow even if you're asking for the "full report."

Different sleep labs have different software and different formats for presenting the info in reports. Some labs probably wouldn't bother to give you some of the things that you see on mine like the titration table and sleep architecture chart even on a "full report" unless you ask specifically that those items be included.

Sleep study reports

[ufo13]

yardbird:

My study was done many years ago and every thing was done in one night (sleep study-titration). When i requested the sleep study report years later it was 2 pages and all the pertinent data was on the first page. They charged $1 a page. Maybe now with the 2 night study-titration etc. it entails much more data? So i would just request all that is important and not the filler pages etc.

hope this helps!


steve,
ufo13

[ProfessorSleep]

Mine, also a one night deal, resulted in a 3 page report. I asked the tech in the office for a copy and she provided it free through the docs office. If you have to go through med. records, though, so be it. But it shouldn't be more than a few pages long as the others already have said. By all means, get whatever info you can, even at .75/page.

[Roger...]

You are entitled to have one copy of all documentation generated by a medical service provider. Sleep centers are notorious at not wanting this information to get out because the doctors complain. I would probably pay for the report because the expense is so small, but do so knowing they are in violation of most state laws regarding patient information. Doctors usually do a better job of sharing information when asked directly, so that is another approach if you get bogged down in red tape.

I can't imagine you being required to fill out a "patient information release form" to get access to your own records. Somebody in the process is sure short on training.

[Guest]

When I asked the MD for mine, what I received was about one third of a page (a very short summary). It had my AHI, oxygen desat, total apneas, total hypopneas, mixed apneas, and that was it.

I would like to have more, but don't know exactly what to ask for either. I also thought they were required to give you your info if you asked. And I realize that all of it would be too much, but surely there is something more than that one page that they could give a patient.

[elliejose]

Sorry, That last Guest was me.

[christinequilts]

I can't imagine you being required to fill out a "patient information release form" to get access to your own records. Somebody in the process is sure short on training.

It's pretty standard to have to fill out a patient information release or some other written request that includes name & other pertenant info, and your signature since the HIPPA law went into effect a couple years ago. I know the law allows for copying fees, but I can't remember if they cap the amount...I think its worded something like 'reasonable' charge allowed? It depends on the place how they handle it- my sleep lab is really good about getting copies of anything I need with no charge. Another office had a set charge of $15 for the entire chart or 25cents per page. When I had to request records from a hospitalization, I was told I could get X number of pages for free and pay so much for each additional pages I might need- they were pretty good about knowing which pages would be most important.

[Roger...]

What documents to seek from the sleep center testing:
In the few reports that I've seen, there is usually a cover page where the information is summarized. This is typically written by the sleep doctor at the clinic or as a service to the clinic by an outside MD. Outside MD reports do a lot of guessing, so knowing who and where the person was when the report was written might improve you understanding and confidence in the report.

After the Summary, look for a page where all the items listed explain what was observed and recommended. Many centers are using machine scoring and still use the old Alice software. From the studies I’ve read, the new Alice software does a good job, but versions 3 and earlier seem to make a lot of mistakes. Ask about the software that is used in recording and scoring the information. Also, if they tell you they hand score the report, more than likely they care enough to be accurate.

Here is what was on my second page of the report:

OVERNIGHT POLYSOMNOGRAPHY REPORT

PATIENT: ROGER...

DATE OF STUDY: 9/1412005

INDICATIONS:
This is a tired old man that makes noise when asleep and is becoming more than grumpy.

PROCEDURE:
An all night comprehensive sleep study was performed in which the following medical parameters were recorded using a Healthdyne model Alice 3 computerized polygraph, left central (C3), central (CZ), occipital (OZ) and frontal (FZ) electroencephalogram, left and right electrooculogram, electrocardiogram, submental & anterior tibialis electromyogram, nasal/oral airflow, oxygen saturation (pulse oximetry), chest & abdominal effort belts, sonogram (snoring) and body position monitor. The study was attended by polysomnographic technologist (PSGT) and the raw data was manually reviewed and interpreted by xxxxxxxxxxxxx, M.D., Diplomate of the American Board of Sleep Medicine. The recording started at 9/15/2005 at 10:42:55 PM, 9/15/2005 at 5:31:55 AM.

DEFINITIONS:

• Apnea=cessation of airflow for 10 seconds or greater.
• Hypopnea => 50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%
• Apnea/Hypopnea Index (AHI)=apnea plus hypopnea/hour of sleep.
• Respiratory Arousal Index (RAI)=AHI + snoring related EEG arousals.
• Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
• Sa02 Scale: > 89% (none), 85-89% (mild), 80-84% (moderate), <80% (severe).

CONCLUSION:

• Moderate obstructive sleep apnea with an Apnea/Hypopnea Index (ABI) of 27.5 per hr.
• Severe Sleep related oxygen desaturations.
• Sa02 Nadir of 78 percent from a sleep baseline of 92%.
• Severe respiratory related sleep fragmentation with a Respiratory Arousal Index (RAI) of 39.48 per hr.
• Moderate to loud snoring was noted.
• ECG/EKG abnormalities were not noted.
• EEG or EMG abnormalities were not noted.
• Average duration of hypopneas was 21.2 seconds.
• Maximum duration of hypopneas was 37.0 seconds.
• Average duration of apneas was 17.0 seconds.
• Maximum duration of apneas was 21.5 seconds.
• CPAP was not applied due to lack or sleep efficiency. Sleep efficiency of only 60.6% did not allow enough time to properly make an evaluation. A longer diagnostic was needed to better access the patient's severity.

DISCUSSION:

• Once asleep, the patient demonstrated moderate-loud snoring and repetitive obstructive apneas and hypopneas with an overall apnea/hypopnea index of 28 per hour, placing the patient in the moderate category. Obstructive events were associated with severe oxygen desaturation to as low as 78%.
• There were no EKG abnormalities.
• There were no REG abnormalities.
• There were no periodic limb movements.

Options for treatment of this patient's obstructive apnea include the following:

1. Discuss the importance of weight loss, if indicated
2. Discuss the role of alcohol and sedative/bypnoties in causing or worsening existing obstructive apnea
3. CPAP/BlPAP
4. Dental appliances
5. Surgery

Recommendations should be made based on a thorough evaluation of the patient. Clinical correlation is suggested.

SLEEP ARCHITECTURE BASELINE PORTION OF THE STUDY:

Code: Select all

TOTAL SLEEP TIME:       231.0 min.
TOTAL TIME IN BBD:      381.0 min.
TOTAL WAKE TIME:        0.00 min.
SLEEP EFFICIENCY:       60.6%
LATENCY TO SLEEP ONSET: 11.5 min.
LATENCY TO REM ONSET:   363.0 min.

SLEEP STAGES:

Code: Select all

                     Minutes     %TST
Stage I:             46.0        19.9
Stage 2:             167.0       72.3
Stage 3:             13.0        5.6
Stage 4:             0.0         0.0
REM Sleep:           5.0         2.2
 

AROUSALS:

Code: Select all

                                 NUMBER      # PER HOUR
EEG AROUSALS (TOTAL):            180.00      46.75 per hr.
RESPIRATORY & SNORING AROUSALS:  152.00      39.48 per hr.
PLMS AROUSALS:                   0.00        0.00 per hr.
NON-SPECIFIC AROUSALS:           28.00       7.27 per hr.

RESPIRATORY EVENTS:

Code: Select all

                                  # PER HOUR:
Apneas:                             6
Hypopneas:                          100
Total apneas/hypopneas:             106
Apnea/hypopnea Index:               27.5
Snoring related EEG arousals:       11.95
Respiratory Arousal Index:          39.48
 
Body Position Table           Supine         Left        Right       Prone
TST in min.                   9.93           45.51       175.42      0.10
Sleep %                       10.64          74.00       86.20       20.00
REM %                         0.00           0.00        2.50        20.00
CA                            0.00           0           0           0.00
OA                            0.00           0           6           0.00
MA                            0.00           0           0           0.00
Hypopneas                     3.00           19          78          0.00
AI (#/Hr)                     0.00           0.00        2.05        0.00
AHI (#/Hr)                    18.13          25.05       28.73       0.00
RAI (#lHr)                    24.18          46.14       38.65       0.00
Snore Arousals                1              16          29
SaO2 Nadir                    89%            89%         78%

SLEEP STAGES:

Code: Select all

               TST:        AHI:           Average     Min
                                          SaO2:       SaO2:
REM:           5.0 min.    72.0 per hr.   90%         78%
NREM:          226.0 min.  26.5 per hr.   92%         86%

DURATION OF APNEA/HYPONEA:

Code: Select all

                              APNEA          HYPONEA
Average duration:             17.0 seconds   21.2 seconds
Maximum duration:             21.5 seconds   37.0 seconds

OXYMETRY SUMMARY:

Code: Select all

Desaturation Index (number per hour):                 13.8
Baseline 02 saturation (Awake):                       93
Baseline 02 saturation (NREM):                        92
Baseline 02 saturation (REM):                         90
Minimum oxygen saturation with a respiratory event:   78
 
Oximetry Table    WK       REM      NREM        Total
<75 (min)         0.01     0.0      0.0         0.0
<80 (min)         0.0      0.0      0.0         0.0
<85 (min)         0.5      0.5      0.5         1.5
<90 (min)         2.5      1.5      14.5        19.0
 

CARDIAC EVENTS: Average heart rate waking: 86.4, NREM: 75.5, and REM: 71.0.

On my third page of the report is the actual Polysomnography chart. To see what mine looked like, click on the next link and it should appear. The image that surfaces has been annotated so it can be understood. It is also very wide so you’ll need to scroll to see it if your OS version doesn’t compress the image.

Polysomnography Report (click here)

Your Polysomnography chart won't have the same level of details in the labels, but the lines on the page should cover the same range of information and the same categories should be present so that you can use the label definitions to understand your report.

Everyone going through the pain of sleep study should ask up front for a copy of the report and make it a condition of the study agreement. I did, and had to remind the sleep center once a week for three weeks to get my copy faxed here.

[Ric]

My physician is affiliated with a local medical center. The records are managed by the hospital "information management" department, (formerly known as "medical records"). There I have the option of just reviewing the records, (just sitting there reading them while someone sits across the table to make sure I don't steal or alter them, which is reasonable). I can then request specific pages, or the entire document, my choice. They charge 25 cents a page to copy and release. The applicable law states that they can only charge a reasonable cost for copying and delivering them. Just looking is free. (Same as Nordstrom's).

I think Roger is correct in stating that test results are not generally released directly to the patient by the techs or the lab. I actually support that concept, I think the ordering physician should have the first crack at reviewing and interpreting the information. But having said that, you the patient ABSOLUTELY have a right to a copy of the report. That doesn't just apply to sleep studies, but all information in your medical record. And I also strongly encourage everybody to have a copy of their own sleep study and understand what it means, every little detail.

(I should mention that from a legal standpoint, the above remarks do not necessarily apply in all countries, I don't really know. In the U.S. it carries the weight of federal law, and some states are even more stringent in that they grant more patient rights than are required by the federal govt.)

-Ric

[JCraig]

I had a split-night study, and the report is 7 pages. Luckily, my GP faxed a copy to me for free.

[Roger...]

Hello Ric,
Glad you were able to get the reports.

In your post you mention the sleep study details going directly to the MD, and for the most part this is probably okay with some exceptions. In my case, my last sleep report was corrected at least three times because of errors made by the reviewing MD associated with the sleep center. It became comical at one point and when my MD got three of them he didn't know what to believe or think until I told him how much they messed up the details.

My recommendation is, regardless of who gets the report first, be sure the things indicated in the comments are correct. My comments were wrong, but the number were probably right. Of course with the comments being so off the wall, and the sleep center confirmed they were wrong all three times, I had no way of challenging the numbers presented.

[Snoredog]

Hello Ric,
Glad you were able to get the reports.

In your post you mention the sleep study details going directly to the MD, and for the most part this is probably okay with some exceptions. In my case, my last sleep report was corrected at least three times because of errors made by the reviewing MD associated with the sleep center. It became comical at one point and when my MD got three of them he didn't know what to believe or think until I told him how much they messed up the details.

My recommendation is, regardless of who gets the report first, be sure the things indicated in the comments are correct. My comments were wrong, but the number were probably right. Of course with the comments being so off the wall, and the sleep center confirmed they were wrong all three times, I had no way of challenging the numbers presented.

your report looks very similar to mine, did your report happen to come from the ContraCosta Sleep center in Walnut Creek?

That lab has a generic template they use to write those reports and they don't appear to change what it says from patient to patient, when I had my PSG done I only weighed 177lbs. and was 6' 1", the report said I weighed 225lbs. and should consider losing some weight.

When I seen my sleep doc during the followup, I asked him when did you guys weigh me? I know the sleep lab didn't. He looked at me, said just ignore that part.

[Roger...]

My sleep study was created by the Sleepmed Center in San Jose, CA. They don't have a local MD on staff. Instead they use a sleep doctor in Los Angeles who does the reports at night in his spare time.

I'm almost certain my report was commented while he was passing the salad or the potatoes at the dinner table, or while talking on the phone. It had to be that because I don't know how a person could get so confused in what they were writing.