Anyone Care to Interpret Sleep Study

Anyone Care to Interpret Sleep Study....

Thanks

I find it interesting that there are no leak rate or cumulative leak stats. They've prescribed a 'chin strap if needed' (which is not always effective) and a FFM, but none of the results address leaks (which may not be large at all). It's also interesting that they say if symptoms persist you should be seen by a sleep specialist (why weren't you referred to begin with?).

I find it interesting that you had no respiratory events under treatment at any pressure. I'm not an expert, so I wonder how they arrived at a recommendation of Auto with a range of 10-16 cmH2o. If that were my study, I would be tempted to try straight CPAP at 6 cmH2o. But again, I am no expert.

Jay respiratory events were 45 total and 35 AHI. Yoy didn't go up far enough

EDIT: ME BAD you said under treatment...sorry

Like Jay,

I find it odd that they kept titrating up and up and up all the way to 13cm without any recorded events. Nor is there any note about snoring on the titration part of the test. There are, however, several comments about the SaO2 levels during the titration part of the test. From the page 2 summary data:

• there were 19 desat incidents while using CPAP
• there was a minimum SaO2 of 88% at 7cm of pressure
• there was a total of 5.9 minutes with an SaO2 < 90% during the CPAP titration part of the test.
• minimum SaO2 levels are 90% at 6, 8, 9, and 10cm of pressure
• minimum SaO2 drops to 89% at 11cm
• minimum SaO2 is above 90% at 12 and 13cm of pressure

Perhaps the drops in SaO2 while on CPAP was why they kept increasing the pressure.

Of course, that then begs the question: If there are no respiratory events scored during the CPAP titration part of the test, why did you keep having desats? Perhaps there were some serious flow limitations going on that did not last long enough or were not severe enough to be scored as hypopneas or apneas. And perhaps the flow limitations started to clear up by the time the pressure was around 10-12 cm.

The recommendation to start APAP with a rather narrow range of pressure (10-16cm) and download the data in 4 weeks is a sign of a quality sleep doc: Someone is actually interested in seeing just how well PAP is working in your own bed every night. They may also be a bit concerned that without seeing any supine REM sleep on the overnight test, they have not had a chance to discover if you need even more pressure to take care of all the events.

I'd also add one other thing that is missing from the recommendations: I'm wondering if this is a case where a recording oximeter might be useful since you continued to have some potentially significant minimum SaO2 numbers while on PAP.

Interesting points, Robysue.
It also looks (to me) as if there is a lot of fluctuation in the heart rate. FDW has previously stated he has a pacemaker/defibrillator. I wonder if these desats might be cardiac rather than respiratory related. Though the heart rate trace may be completely normal, again I'm no expert, but the "EKG showed an abnormal rhythm". If I were FDW, I think I'd send a copy of the study to my cardiologist just for review.

Jay Aitchsee wrote:Interesting points, Robysue.
It also looks (to me) as if there is a lot of fluctuation in the heart rate. FDW has previously stated he has a pacemaker/defibrillator. I wonder if these desats might be cardiac rather than respiratory related. Though the heart rate trace may be completely normal, again I'm no expert, but the "EKG showed an abnormal rhythm". If I were FDW, I think I'd send a copy of the study to my cardiologist just for review.

I agree, the heart rate chart was the thing that first jumped out at me when I looked at the report. I don't think that you're meant to see results like that with a pacemaker when you are supposedly in a resting state.

The other thing was the SaO2. Those quick drops suggest that maybe the chin is too close to the chest or once again that there are cardiac anomalies.

Putting these two things together a 'peace of mind' visit to the cardiologist might be in order. He/she will be able to explain it far better than any of us.

I'm due to see mine in a couple of weeks and I'll take some of my SH data for him to look at.

Holden4th wrote:The other thing was the SaO2. Those quick drops suggest that maybe the chin is too close to the chest or once again that there are cardiac anomalies.

those downward spikes are much more likely to be reading glitches caused by movement.

palerider wrote:

Holden4th wrote:The other thing was the SaO2. Those quick drops suggest that maybe the chin is too close to the chest or once again that there are cardiac anomalies.

those downward spikes are much more likely to be reading glitches caused by movement.

I agree that there are some likely artifacts that are probably caused by movement in that SaO2 graph.

However the summary data indicates that there was a total of 5.9 minutes of sleep with the CPAP on and with an SaO2 < 90%. I doubt that data includes obvious artifacts. And even if it did, how likely would there be enough artifacts to add up to 5.9 minutes?

And if it's not the O2 levels, then why did the tech continue to increase the pressure from 6 all the way up to 13?

robysue wrote:

palerider wrote:

Holden4th wrote:The other thing was the SaO2. Those quick drops suggest that maybe the chin is too close to the chest or once again that there are cardiac anomalies.

those downward spikes are much more likely to be reading glitches caused by movement.

I agree that there are some likely artifacts that are probably caused by movement in that SaO2 graph.

However the summary data indicates that there was a total of 5.9 minutes of sleep with the CPAP on and with an SaO2 < 90%. I doubt that data includes obvious artifacts. And even if it did, how likely would there be enough artifacts to add up to 5.9 minutes?

And if it's not the O2 levels, then why did the tech continue to increase the pressure from 6 all the way up to 13?

it's really hard to read the spo2 chart with the y axis so scrunched, it'd be much more meaningful if it autoscaled to something useful, in this case say 85-95.

if you look up on page 2 on the titration chart, it shows min spo2 at various settings, and it does show 85 as min at zero pressure. the lowest at any other pressure was 88.

Reading the recommendations, it sounds like they were trying to titrate up to limit periodic limb movement. You continue to have desats, but even your baseline oxygen isn't fantastic. I'm surprised they didn't try adding oxygen.

Here are a couple posts from one of fdw's older threads. After reviewing them, I feel even stronger that this current study should be referred to his cardiologist.
My guess is the sleep lab recommended auto 10-16, EPR 3 based on what he told them he was using before this study was done (and/or to bracket his previous titration results).

viewtopic.php?f=1&t=103187&p=969600&hil ... ee#p969600

fdw wrote: Thu Jan 29, 2015 12:35 pm Well it's been nearly 2 weeks since my last post on this question as promised. But I have to add some more information about my health.
Next week I will be having Arterial Fibrillation ablation for the second time next Friday. First time was in July 2014. ICD implanted October 2014.
I really want to have my pressure optional as possible......Since switching to straight CPAP from APAP I have been feeling a little better (not as many skipped heart beats).
As I've stated in the past my last official titration was in 2007 at 13.0 CPAP.
Here is last nights results and was actually in A-Fib part of the night, went to bed in A-Fib.
Any suggestions or recommendations..........BTW would EPR set at 1 be a causing any issues
Thanks

Jay Aitchsee wrote: I think you should be taking these charts to your heart guy and your sleep guy and get their opinion! Best would be to get them working together to optimize your treatment. BTW, they might prefer to see the ResScan reports rather than SleepyHead. Some providers tend to dismiss SleepyHead.

fdw wrote:I don't have a sleep guy......and Im sure my cardiologist and electrophysiologist would say "nice graphs". They deal with the heart and not OSA, however they have said that OSA is a major factor with a person with AF. I've always said I need a doctor like Dr. House (from the TV show).

Jay Aitchsee wrote:Yes, I've read that OSA is associated with Afib, here's one article: http://www.medscape.com/viewarticle/776107. Maybe you should ask your cardiologist to recommend a good sleep certified pulmonologist. Although your cardiologist might surprise you, he might very well be able to discern things in your flow rate chart related to cardio function.