Interpreting my Sleep Study Results

[OnlineAl]

Hey all, I recently had an at-home sleep study performed and just got the results. I cannot see the doc until late February so I have been trying to do some research on my own end so I can go to the appointment educated. That being said, any help or comments about these results? Does it warrant a CPAP or should I just try the mouth guard option?

Interpretation:
The patient was studied in several positions, including the multiple positions, including the supine position. Monitoring did reveal the presence of snoring. Respiratory events were noted to be obstructive in etiology and mild oxygen desaturation was present. Baseline parameters revealed the number of apneas/hypopneas per hour of recording (AHI) or respiratory event index was 5.3 events/hr. The SpO2 nadir was 88%. The patient spent 0.2 minutes of the recording at SpO2 <90%. The lowest heart rate was 45 bpm and the highest heart rate was 106 bpm during the study.

Study quality: Oximeter 100%; Flow 100%; RIP 100%

Impressions:

Mild Obstructive Sleep Apnea without associated hypoxemia and with evidence of hypersomnolence (Epworth Sleepiness Scale 10).

Portable monitoring may underestimate the severity of OSA given lack of EEG monitoring (overestimation of sleep and lack of arousal scoring and associated hypopneas scoring).

Decreased supine positioning may have decreased the severity of the reported Sleep Related Breathing Disorder.



Specific Recommendations:

Trial of PAP therapy with autoPAP 5-15 cm H2O with interface of patient's choice and heated humidity.

Essentially, If CPAP, used effectively, produces a salutary effect on the subjective symptoms (daytime fatigue), one might feel more likely to attribute those symptoms to the respiratory events identified, and continued use of CPAP may be beneficial. Likewise, alternative treatment with a mandibular repositioning device may be considered if clinically indicated and patient has a good response to treatment.

If CPAP, used effectively, were to fail to produce evidence of subjective benefit, it would seem less likely that those symptoms would be attributable to sleep disordered breathing; CPAP could be discontinued, and alternative explanations for the patient’s symptoms would need to be considered.

[LSAT]

To me, it sounds inconclusive....According to the report, you are on the low end of Mild. If you have insurance to cover the machine and mask, you might give it a try. Your AHI was 5.3...Generally under 5 is considered normal by the medical community.

[Miss Emerita]

Can you tell us something about what led to the sleep study? In particular, what experiences were you having that resulted in the study?

[Pugsy]

Home sleep study done. Probably finger oxygen sensor and some nasal cannula for breathing....maybe a chest/thoracic/abdominal belt but nothing done with EEG sensors to even know if you were asleep or not.
So either a type 3 or type 4 sleep study. Not very comprehensive.
http://freecpapadvice.com/home-sleep-tests
They can be fairly accurate when OSA is easy to spot....like marked oxygen drops or AHI of 20 something.
Not so accurate when the results are borderline and they can't even be sure a person was even asleep or not.

I know a guy who had a home study and came away with AHI of nearly 8 but he said he never really slept all that much and he didn't believe the results. So he fought for an in lab sleep study and guess what...no OSA and AHI was less than 2.0 which is considered normal.
Now he had none of the usual symptoms of OSA though. He was forced to take the home study because of his job criteria.

You are having some apparent symptoms that could be caused from OSA so your situation is a bit different.
The AHI from the home sleep study...barely meets diagnostic criteria which in the USA is 5 AHI or more AND experiencing symptoms.

There's also a little sleep disordered breathing problem called UARS Upper Airway Resistance Syndrome that might be a potential culprit.
You can look it up. You can't make a diagnosis for it relying on AHI. Most of the people with UARS have AHI numbers that are quite unremarkable. They have a lot of sleep disturbances due to airway issues though...and first thing we need to know is sleep status and with the type of home study you had...zero way to know if you had the arousals normally seen with UARS because there was no way to know if you were asleep or not. I mention this as possible diagnosis. I have no way to know if that fits you or not.

If it were me....before I did anything I would want a sleep study measuring sleep status to know if I was asleep or not first.

[OnlineAl]

Can you tell us something about what led to the sleep study? In particular, what experiences were you having that resulted in the study?

Thanks for your response. I decided upon the sleep study because I have always struggled with feeling tired (I get my full bloodwork done 3x a year - everything decent) and my girlfriend says I snore like crazy and stop breathing in my sleep frequently. Sometimes I even wake myself up from not breathing. To be honest, I was expecting my AHI to be much higher than it is due to my symptoms

[OnlineAl]

Home sleep study done. Probably finger oxygen sensor and some nasal cannula for breathing....maybe a chest/thoracic/abdominal belt but nothing done with EEG sensors to even know if you were asleep or not.
So either a type 3 or type 4 sleep study. Not very comprehensive.
http://freecpapadvice.com/home-sleep-tests
They can be fairly accurate when OSA is easy to spot....like marked oxygen drops or AHI of 20 something.
Not so accurate when the results are borderline and they can't even be sure a person was even asleep or not.

I know a guy who had a home study and came away with AHI of nearly 8 but he said he never really slept all that much and he didn't believe the results. So he fought for an in lab sleep study and guess what...no OSA and AHI was less than 2.0 which is considered normal.
Now he had none of the usual symptoms of OSA though. He was forced to take the home study because of his job criteria.

You are having some apparent symptoms that could be caused from OSA so your situation is a bit different.
The AHI from the home sleep study...barely meets diagnostic criteria which in the USA is 5 AHI or more AND experiencing symptoms.

There's also a little sleep disordered breathing problem called UARS Upper Airway Resistance Syndrome that might be a potential culprit.
You can look it up. You can't make a diagnosis for it relying on AHI. Most of the people with UARS have AHI numbers that are quite unremarkable. They have a lot of sleep disturbances due to airway issues though...and first thing we need to know is sleep status and with the type of home study you had...zero way to know if you had the arousals normally seen with UARS because there was no way to know if you were asleep or not. I mention this as possible diagnosis. I have no way to know if that fits you or not.

If it were me....before I did anything I would want a sleep study measuring sleep status to know if I was asleep or not first.

Thanks for your response - greatly appreciated. You are absolutely right, the study I did had a nose cannula, finger oxygen sensor, and some sort of chest apparatus. The reason for the test is due to a lifelong "issue" with being a very loud snorer and my girlfriend saying I habitually stop breathing in my sleep - hence why I am a little surprised my results were mild. Based upon your advice, sounds like I need a more comprehensive test done before going the route of the CPAP?

[Pugsy]

The snoring all by itself could be a major sleep disrupting culprit. Now is the snoring because of OSA airway issues???? Million dollar question but it sure wouldn't be impossible.

So since we now know that even without a for sure markedly high AHI on the sleep study because amount of actual sleep is in question....the fact someone else says you snore something awful...that sort of changes things.

Maybe give cpap a try and see what happens and if it doesn't help then push for a more comprehensive sleep study.

[OnlineAl]

The snoring all by itself could be a major sleep disrupting culprit. Now is the snoring because of OSA airway issues???? Million dollar question but it sure wouldn't be impossible.

So since we now know that even without a for sure markedly high AHI on the sleep study because amount of actual sleep is in question....the fact someone else says you snore something awful...that sort of changes things.

Maybe give cpap a try and see what happens and if it doesn't help then push for a more comprehensive sleep study.

Sounds like the right plan - thank you. I'll see what the doc has to say in a month as well

[Miss Emerita]

It's good your doctor is open to a PAP trial. I recommend that you advocate for a ResMed Airsense 10 Autoset (or Autoset for Her, can help both men and women). If your sleep is disrupted by UARS or by flow limitations, this machine will be a better bet than its main competitor (Philips Respironics Dreamstation). The ResMed machine is more nimble, is less likely to make you feel you're being hustled along in your breathing pattern, and is able to provide true pressure support to help with flow limitations. (The pressure support is called expiratory pressure relief; the PR machines use something called flex, which can't provide the same help.)