Titration Study Results - Help with Interpretation

StillAnotherGuest · Post by **StillAnotherGuest** » Sun Feb 11, 2007 7:06 pm

84 arousals in 6.5 minutes would be an arousal index of 775.4, that's getting up there.

By definition, the shortest arousal is 3 seconds, and the shortest period of intervening sleep must be 10 seconds, so theoretically, the most REM arousals you could have in that period is 30.
SAG

SleepySandy · Post by **SleepySandy** » Sun Feb 11, 2007 8:40 pm

A typo is an understatement.

I reversed all of the REM and NREM numbers.

I had 84 NREM arousals / 8 REM arousals.

I hope you all will forgive my great big mistake and still help me with this.

I have another post nearly ready - it lists all of my data from both studies and should be correct.

SleepySandy · Post by **SleepySandy** » Sun Feb 11, 2007 9:00 pm

I apologize again for the big mistake I made in my initial post. I'm hoping I didn't do myself in on this forum because I do still need help figuring this out.

My fatigue is completely debilitating. I'm much more tired than I was before my first sleep study. At this point, I am so tired I can't focus on much of anything or, apparently, accurately type sleep study results. I work part-time from home writing software requirement documents. I cannot focus enough to get anything done. This is completely unlike me. I've always been an overachiever and I've always been able to push through my fatigue. Now, I stare at my computer and wish I could go to sleep. It's not just my work that's affected. I don't make plans because I don't know if I'll be too tired to do them. My husband taking care of most of the housework. I'm extremely frustrated.

I'm would really appreciate any additional thoughts on why I am still so completely exhausted.

Kathy suggested I look at my study data side by side, but I'm not sure how similar / different certain things should be. I thought I would post the side by side information here (this includes more information from my titration study than my first post did and I just double-checked the REM / NREM numbers).

Code: Select all

                           Initial        Titration
Sleep Summary
Lights Out                 21:30:34       22:17:34
Lights On                  05:59:04       05:04:04
Total Study Time           552.1          415.5
Time in Bed                508.5          406.5
Sleep Period Time          494            301
Total Sleep Time           430            251
Total Wake Time            78.5           155
Sleep Efficiency           84.6%          61.7%
Sleep maint. Efficiency    87.0%          83.4%
Sleep Latency              14             52
Latency to REM             215.5          289.5

Sleep Stage Summary
WASO Duration (min)        65             50
WASO % SPT                 13.2           16.6
WASO Latency (min)         2              75.5
Stage 1 Duration (min)     85             46
Stage 1 % SPT              17.2           15.3
Stage 1 Latency (min)      7.5            52
Stage 2 Duration (min)     153.5          134
Stage 2 % SPT              31.1           44.5
Stage 2 Latency (min)      23             58.5
Delta Duration (min)       108.5          64.5
Delta % SPT                22             21.4
Delta Latency (min)        35.5           24
Total NREM Duration (min)  347            244.5
Total NREM % SPT           70.2           81.2
REM Duration (min)         83             6.5
REM % SPT                  16.8           2.2
REM Latency (min)          215.5          289.5

Respiratory Summary
AHI                        14.1           0.7
Total # Apneas             34             3
Total # Hypopneas          67             0
Total # Respiratory Events 101            3
Mean SaO2 %                97             97
# Desats                   77             0
Lowest SaO2 desat %        91             0

Limb Movement Summary
Total # LMs                108            29
LM Index                   15.1           6.9
Total # PLMs               196            91
PLM Index                  27.3           21.8
Total # PLMS w/arousal     22             6
PLMs w/arousal Index       3.8            1.5
Total # RRLMs              24             0
RRLMs Index                3.3            0

Sleep Continuity: NREM Arousals
Spontaneous                6              15
Spontaneous Index          1.0            3.7
Resp Events                58             3
Resp Events Index          10.0           0.7
RERAs / Snoring            272            46
RERAs / Snoring Index      47.0           11.3
Desaturation               0              0
Desaturation Index         0.0            0.0
Limb Movement              16             14
Limb Movement Index        2.8            3.4
PLMs                       22             6
PLMs Index                 3.8            1.5
RRLM                       0              0
RRLM Index                 0.0            0.0
Total Arousals             374            84
Total Arousal Index        64.7           20.6

Sleep Continuity: REM Arousals
Spontaneous                0              3
Spontaneous Index          0.0            27.7
Resp Events                43             0
Resp Events Index          31.1           0.0
RERAs / Snoring            40             4
RERAs / Snoring Index      28.9           36.9
Desaturation               0              0
Desaturation Index         0.0            0.0
Limb Movement              3              1
Limb Movement Index        2.2            9.2
PLMs                       2              0
PLMs Index                 1.4            0.0
RRLM                       0              0
RRLM Index                 0.0            0.0
Total Arousals             88             8
Total Arousal Index        63.6           73.8

Sleep Continuity: Total Arousals
Spontaneous                6              18
Spontaneous Index          0.8            4.3
Resp Events                101            3
Resp Events Index          14.1           0.7
RERAs / Snoring            312            50
RERAs / Snoring Index      43.5           12.0
Desaturation               0              0
Desaturation Index         0.0            0.0
Limb Movement              19             15
Limb Movement Index        2.7            3.6
PLMs                       24             6
PLMs Index                 3.3            1.4
RRLM                       0              0
RRLM Index                 0.0            0.0
Total Arousals             462            92
Total Arousal Index        64.5           22.0

Interpretation for Initial Study:
Sleep architecture was severely fragmented with a total of 462 arousals recorded. REM sleep was slightly reduced. Snoring was continuous and moderate in severity. Apnea-hypopnea index was moderately elevated at 14 events / h (normal < 5) yet what was most impressive was the frequency of relative airflow limitation that was terminated by an arousal/snore as is seen with upper airway resistance syndrome (UARS). Periodic limb movements were frequent as well totaling 196 or 27 per hour yet are likely secondary to the patient's sleep disordered breathing.

Interpretation for Titration Study
1. Baseline moderate OSA with AHI 14
2. Average AHI on CPAP 0.7
3. Improved sleep architecture from baseline with reduction in total arousals from 462 to 92.
4. Optimal CPAP at 10 cwp

I'm being very compliant with my CPAP, which is set to a pressure of 10. I have EncorePro, so I'm monitoring my numbers closely. My AHI is averaging 2.5. I don't have any large leaks. At my appointment on Wednesday, my sleep doc said my CPAP numbers are where they should be.

That's all I can think of.

Any additional insights are appreciated.

Sandy

pedroski · Post by **pedroski** » Sun Feb 11, 2007 9:05 pm

Hey Sandy,

The inability to concentrate properly is one of the symtoms of OSA, and you'll notice lots of mistakes in posts here. You are not writing a thesis, just asking for help, and we all make mistakes. This is a pretty understanding community.

Good luck as the knowledgeable guys chime in to help you out.

Peter

StillAnotherGuest · Post by **StillAnotherGuest** » Sun Feb 11, 2007 10:09 pm

I would also suggest looking at the medications you're on, the REM distribution certainly suggests a medication effect. The graphs might be helpful if you can get them.
SAG

dsm · Post by **dsm** » Sun Feb 11, 2007 10:40 pm

one thing that caught my eye was the line about 77 destats
& the lowest desat being 91% ?

My 1st reaction is that if the Spo2 is over 90, surely that isn't a desat. This leads me to ask the experts who know, just what constitutes a desat ?

DSM

SleepySandy · Post by **SleepySandy** » Sun Feb 11, 2007 11:32 pm

I would like to confirm that the numbers DSM is asking about are not errors.

My first study did show 77 desats with the lowest desat at 91%

SleepTech · Post by **SleepTech** » Mon Feb 12, 2007 7:19 am

kteague wrote:Been dealing with this stuff for ten years as a patient, but still so much to learn. Can you help me understand how the tests interpret a situation where an arousal is recorded when an obstructive event is happening simultaneously to a PLMD movement? I'm speaking of times when either would have happened independently in the other's absence. How does the data reveal which caused the arousal? Are these by default counted as respiratory arousals?
Kathy

Obviously the PLM's with arousals are the important leg movements to take into consideration. It does happen at times where a leg movement and airflow reduction happen close to the same time, followed immediately by an arousal (and if any other techs on here read this I'm sure they'll agree), it really depends on the tech thats scoring that study. One thing to look at is if the Leg kick happened slightly before the arousal, in such a case the tech may score it as a PLM w/ arousal. Though more often than not it would be scored as a repiratory event w/ arousal.

There are really so many things to take into consideration, if the patient has alot of PLM's they will pop out, so scoring a resp. event over a PLM wouldn't generally sway it too much. Also you have to consider if the Patient is on their diagnostic study or on their CPAP study. If they are getting titrated, those resp. events will eventually disappear (or atleast thats the goal), leaving those pesky leg movements w/ arousals sticking out like a sore thumb. Though the tech may not realize the severity of the leg kicks in time to medicate the patient that night (due to resp. events covering them up), the proof will be there for the doctor to take leg medication into consideration.

So I guess to answer your question, its truly up to how that perticular tech wants to score that. More often than not though, the respiratory event is treated first, and if the patient has PLMD it will stand out in the end, hopefully in time for the tech to treat it that night.

Chris

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CPAPopedia Keywords Contained In This Post (Click For Definition): Arousal, CPAP

SleepTech · Post by **SleepTech** » Mon Feb 12, 2007 7:28 am

dsm wrote:one thing that caught my eye was the line about 77 destats
& the lowest desat being 91% ?

My 1st reaction is that if the Spo2 is over 90, surely that isn't a desat. This leads me to ask the experts who know, just what constitutes a desat ?

DSM

A scorable desaturation is a 4% drop in saturation. So really we could score a desat in a drop from 98% to 94%. Various labs may use a different time line, we generally will score a desat if it falls within 30 seconds.

The reason we track the low saturation is for the purpose of possibly adding O2 for the patient. There are qualifications for adding O2 depending on the situation.

But to answer your question, just a 4% drop in sats qualifies a scorable desaturation.

SleepTech · Post by **SleepTech** » Mon Feb 12, 2007 7:47 am

I need to learn how y'all quote several times in one reply.....lol

Sandy,

In taking a quick look (I dont have a ton of time at the moment). BTW, nice catch on the REM to NREM arousals SAG....that shoulda stuck out like a sore thumb.....ah well.

I noticed your spontaneous arousals grew considerably in most every category. That could be attributed to over titrating at a certain time throughout the night, if that is that case hopefully the final pressure you've been given eliminates all or most of those spontaneous arousals. Another thing to consider is you may be getting spontaneous arousals (especially in REM) from mouth leaks. I noticed your using an internasal mask, and if your getting even a slight mouth leak while your sleeping that could cause an arousal. I really suggest using a chin strap....I know the dreaded chin strap, but if mouth leaks are the issue it can help. Though I will say a chin strap wont always cure the leaks.

Just a thought. As I said before, a study can look alot worse than it really is, because the tech is literally playing around with different pressures trying to find what works in every position and well as every stage of sleep. The unfortunate thing is when someone is REM dominant or has a positional component, because then you'll see someone that is fine at 5cm of pressure when lateral in Non-REM but will need 17cm of pressure when supine in REM.....its happened.

As far as SAG's suggestion on looking deeper into your medication, it could be a thought, but I'll leave him to give you advice in that category.

OH...also somone else (cant remember) brought up a valid point about caffeine. This is very true, sleep hygiene is very important. Make a nice quiet, dark room for you to sleep in.......well quiet outside of the machine anyways ;-P

Try to avoid anything caffeinated.....even chocolate within a few hours of sleep (4 hours if possible). In fact just avoid eating within a few hours of sleeping, cause if your body is trying to digest food while your sleeping....guess whats happening to your quality of sleep.

Chris

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CPAPopedia Keywords Contained In This Post (Click For Definition): Arousal

SleepySandy · Post by **SleepySandy** » Mon Feb 12, 2007 5:29 pm

Thanks again, everyone. So much information...

The practical tips are excellent suggestions, particularly the medication one. I have several medications I take each morning, but they're things I really won't be able to stop. BUT...I do have a medication I take at bedtime. I had never thought about it possibly affecting my sleep. Now that I've thought about it, I can definitely see how it might be. It's a divided dose (1/2 morning and 1/2 night), so I can't move the night dose to the morning. However, I think I can move it to late afternoon / evening. I'm going to give that a try.

I think I'm good about caffeine. I can't stand coffee or tea, so my only source of caffeine is soda. I do drink 2 sodas a day and always before 4pm. Since I don't drink it late in the day, I'm hoping it's not contributing to my problems. I don't really want to give it up completely yet. I need my Pepsi One!

The food thing is something else I'm going to change. I tend to not eat enough for dinner, which leaves me hungry closer to bedtime. I can't fall asleep if I'm hungry, so I have something before bed. It's always something like a banana or peanut butter toast, but I can see how that just complicates things for me.

I'm glad to have some things I can do while waiting for the blood test results (which won't show anything anyway) and my next sleep doc appointment.

Sleep is amazingly complicated.

Titration Study Results - Help with Interpretation

Gotta Be A Typo

Not really a typo - more like a big giant error

Well, To Start...

Re: Question for the techs out there

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