DO You Have Confidence Your Sleep Study Is Accurate?

I hope someone knowledgeable with sleep study reports, will plow through the reports and give me their opinion. Since 2000, I have had Three sleep Studies and Two Titrations. I don't have confidence the first and last sleep study, and the first titration. They all have been done in accredited sleep labs. You pay for the study, or your insurance does, and your physical well-being, or even your life depends on how accurate they are. What if you were tested for cancer, or heart disease in such uncertain fashion. Are the Sleep Labs ever rated? And, if so, who rates them? And, I may have supicions without valid reason.

Polysomnography Interpretation 3-3-00. Findings:
SLEEP ARCHITECTURE: Tot recorded sleep time was 462 min. Total sleep period was 458 min.Sleep latency 4.5 min. States of sleep: Stage 1=5%, Stage 2=60%, Stage 3 =16%. Rem_6.5%. Latency to Rem was prolonged at 306 minutes. Sleep efficency 87%.
OXYGEN SATURATIONS: Nearly continuous cyclical fluctions in saturation present. Oxy. Sat. fell as low as 77%.
RESPIRATORY EVENTS: Patient presented with severe Obstructive Sleep Apnea with 99 apnea & hypopneas per hr. or slee, most of which were obstructive apneas. Obstrucive brething was much worse while supine (125 events per hr) Snoring was noted frequently
LEG MOVEMENTS: Patient was noted to have 62 leg movements per hr of sleep. Most were associated with respiratory arousals.
IMPRESSIONS: Severe Obs. Slleep Apnea Syndrome. 99 apneas & Hypopneas per hr of sleep, accom. by moderate to severe oxygen desats.
RECOMMENDATIONS: Nasal CPAP with oxygen Titration, regular exercise. Upper Airway Surgical evaluation, is patient candidate for surgical correction of sleep apnea.
TITRATION 4-25-09 FINDINGS:
RESPIRATORY EVENTS & OXGENATION:
Patients oxy. sat. above 90% majority of time. The most striking finding is the difference in natures of apneas. In Previous study, she had predominance of obstructive apnea. In this study, she had central apneas or hpopneas up to 84 events per hr. With Occasional Obstructive apneas up to 16 per hr. Respiratory distress 81 events per hr.
SLEEP ARCHITECTURE: 419 min of recorded sleep. Sleep Latency 67.5 min. Sleep period 346 min. No Rem Sleep during study.
INTERVENTIONS: Nasal CPAP applied & titrated up to 13 cm H2O. Significiant reduction in obst. apneas, but overwhelming apneas eing central, there was little change in condition.
SUMMARY: iN previous study, patient demo. severe obst sleep apnea with hypoxemia. During CPAP trial, slight improvementin hypoxemia, but not ssignificant improvement in sleep architecture. Further, frequent central apneas were noted during CPAP trial. REPORTS were signed by an M.D. who is aa Diplomate, Am. Board of Sleep Med.
Sept 2001, consider UPPP surgery. Dr want another sleep study.
I just have notes on results. It was done in a University Setting. The new Sleep Dr. said previous sleep study and titration were not done according to established protocol. His diagnosis, severe Obstructive Sleep Apnea 84 events per hr. Oxy Sat good. 65 leg movements per hr.Titration 4 cm to 8 cm satisfactory. Dr sd previous study & titration were so dissimilar they could have been different patients.
UPPP surgery in 2003 -
2008 POLYSOMNOGRAM. Medicare will not allow study done in Dr. Office. New Dr has separate entrance for sleep studies. CONCLUSIONS: Patients sleep fragmented between 0030 & 0145 hrs. Total Sleep time 5.59 hrs. Sleep efficency 82% - Normal is equal to 90%. Patient has moderate sleep-disorded breathing. Low oxy 81%, AHI of 18.9 per hr. Patient moderate sleep apnea.+ Patient may suffering from chronic sleep deprivation. Couldnt complete observations, leads came off during study.

I have new sleep doctor. He would not make observation about sleep study. But is very cooperative & interested in ResMed data charts I take to his office.

I only did therapy in 2000 for a few months. I couldn't get a mask that did not leak into my eyes. Developed conjunctivitis. So, when I started sleep apnea therapy in January 2009, I was an am, a complete beginner. Appreciate anyone's analysis of my sleep studies. Jan

I can say for sure that my sleep study titration was not accurate, since it said my CPAP setting needed to be 6.0, and I learned more than a year later after finding this forum and checking my numbers that my AHI had averaged 12. I got an auto machine which found my correct minimum pressure of 12.0, and now my AHI averages 0.4. I suspect that most sleep studies produce good results, but I know that some do not, based on my personal experience.

deleted

RipVW,

I still don;t know what all the machines do. Did you find that 12 was your correct number by self-titration? Or How?
Curious for myself. Thanks for your reply.

Jan

Never mind (can't delete apparently).

Hey Jay, Funny post. I didn't take that much (sleeping meds) but on one study, I finally got to sleep 'bout an hour before they came in and woke me up. It was in the summer, and it was still dark outside - I asked the sleep doctor if they didn't send the patients home a tad early. He said, how do you think they get their sleep?

Jan

After knowing others with similar stories I just skipped the sleep study and bought used machines. Maybe not smart but at the time money/time was not in good supply. This August will be five years of CPAP use.

I agree with the doctor that the data brought from home collected in real time in a real bed contains the really useful data.

Well, I'm not going to be much help because I flat out don't know. I have another health condition (COPD) that can distort the entire picture, not so much during the titration, but at home, day to day. I can cruise along w/good data, feeling well, or I can have some not so good nights w/data not looking bad at all. And my days may or may not coordinate w/the data - or the titration. First bi-level titration was IPAP 13, EPAP 5. Six months later titration at another lab came up w/IPAP 10, EPAP 5. What the h*ll do I know? I'm "just" the patient!

Ha! GaleHawkins, that is only because he was one of the few good sleep doctors out there! Do you have any idea how many sleep doctors have no interest in or actually go into tirades about how inaccurate and reliable the data from these xPAPs are!!

Sleep is such a variable thing. I've had several sleep studies over a 10 year period, and they were expectedly quite dissimilar, but yours are far beyond dissimilar. I think the issue would be which one(s) to trust. It's probably far too late on the old ones, but it sure would be interesting to have the raw data from those tests to be reviewed by knowing eyes. The middle one is too serious to just assume it is wrong, but even on the last one where the lead came off - I wonder why the tech didn't put it back on, unless it was almost wake up time.

I had a doc dismiss the accuracy of the results of one of my studies, saying that they're only as good as the tech performing them and reading them. I'm waiting for those more knowledgeable than I about these things to chime in.

One thing that crossed my mind is complex sleep apnea. Secondly, from personal experience I know how limb movements that are from Periodic Limb Movement Disorder can complicate getting a complete picture of either the apnea or the limb movements, as they can vie for prominence. I'd be interested in knowing what your limb movements look like after getting the OSA treatment to be therapeutic. Maybe they really were just event related, but I can't help but wonder if the two were coming so rapid fire that they appeared connected. Take that with a grain of salt, keeping in mind that my mind immediately goes there because of my personal experience. The liklihood of it applying to many others is not great.

Hope you get things sorted out and you start feeling better.

Kathy

SaltLakeJan wrote:RipVW,

I still don;t know what all the machines do. Did you find that 12 was your correct number by self-titration? Or How?
Curious for myself. Thanks for your reply.

Jan

That is why most on this board push for us to get a Auto machine. It will keep adjusting the pressure until the apneas go away. My sleep study got close. The pressure got me just under the 5.0 AHI mark although the sleep doc told me I could probubly go down a cm/h20 if I wanted to. With the Auto I found out that +2cm/h2o puts me in the 0.5 AHI range. Before my heart problems it had been running around 0.2. Still a lot better than if I had blindly gone with the one night stand.

Jerry

Hello Gale Hawkins;

I don't know enough about the available machines to know if your Remstar Plus can titrate for you. Can you let me know, my sleep doc is considering changing my machine for a bi-level -- I'm not sure what that is.

Well. I can tell you after sleeping in an uncomfortable bed, with a bunch of wires hooked to you, from head to toe - then being awakened before Dawn,and sent home shivering, you sure haven't missed anything. And you know more about your own therapy than most.

I had my last sleep study this last December, it was cold and snowy weather. My dh told the technicians to call him, to come pick me up, before they woke me up. That worked. Thanks for your thoughts they all help.
Jan

I'm not "qualified" to read or comment on sleep study reports, but am pasting some definitions for your benefit to try to make sense out of yours.
Considering your PSG was some years old, it would be of little value at this time, other than that it was a diagnosis and you still have sleep apnea. Our quality of sleep changes from night to night, week to week and month to month. If your "Leg movements" are still a problem, that can (obviously) still be affecting your sleep quality.

In my own case, my titration was quite a ways off. That was evident within about a week of using a data-capable CPAP.

Den

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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/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.

Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%

Stage3&4, REM decrease as we age.


Stuff seen on a PSG Report:

Arousal: An interruption of sleep lasting greater than 3 seconds.

BR Arousal index: The number of breathing related arousals(apnea, hypopnea, snoring & RERAs)multiplied by the # hours of sleep.

Bruxism: Grinding of the teeth.

Central apnea: A respiratory episode where there is no airflow and no effort to breathe lasting greater than 10 seconds.

EEG/EOG: Comments about sleep stages, brain waves (EEG), or eye movements (EOG)

EKG/ECG: Comments about heart rate, abnormal heart beats, etc.

EMG: Comments about leg movements and or teeth grinding (bruxism).

Hypopnea: A respiratory episode where there is partial obstruction of the airway lasting greater than 10 seconds. Also called partial apnea or hypo-apnea.

Non-supine: Sleeping in any position other than on the back.

NSR: Normal sinus rhythm.

NPSG: Nocturnal Polysomnogram, or sleep study.

(#)Number of Awakenings: The number of pages scored as wake after sleep onset.

Obstructive apnea: A respiratory episode where there is a complete cessation of airflow lasting greater than 10 seconds.
PLMs: Periodic limb movements.

PLM arousal index: The number of periodic limb movements that cause arousals multiplied by the number of hours of sleep.

PSGT: Polysomnographic technologist.

REM latency: Latency to REM(dreaming) from sleep onset.

RERAs: Respiratory effort related arousals. Episodes that are not apneas or hypopneas, often related to loud snoring, that generally do not cause a decrease in oxygen saturation.

Respiratory: Any specific comments about respiratory events.

RPSGT: Registered polysomnographic technologist.

Sleep efficiency: Total sleep time multiplied by time in bed.

Sleep latency: The first 30 seconds (one `epoch' of recording time) of sleep.

Sleep onset: The first 90 seconds (3 `epochs) of uninterrupted sleep.

Sleep stage shifts: The number of incidents of sleep stage changes.

Snoring intensity: Level of snoring loudness determined by the sleep technologist. Ranging in degrees from mild to very loud snoring.

Spontaneous arousal index: The number of spontaneous arousals (e.g. arousals not related to respiratory events, limb movements, snoring, etc) multiplied by the number of hours of sleep.

Stage 1: The lightest stage of sleep. Transitional stage from wake. top

Stage 1 shifts: The number of times the sleep stage changed to stage 1.

Stage 2: The first true stage of sleep.

Stages 3/4: The deepest, most restorative sleep.

Stage REM: The dreaming stage; Normally occurs every 60-90 minutes.

Supine: Sleeping on back.

Time in bed: The time in the study from `Lights Out' to `Lights On'.

Total arousal index: Total number of all arousals multiplied by the number of hours of sleep.

Total # of PLMs: The number of leg movements in sleep that last greater than 0.5 seconds.

Total sleep time: Total time asleep.

WASO: Wakefulness after sleep onset.

WNL: Within normal limits.

My first sleep study was "super crappy".......and the second one was just "moderately crappy". I was run through two "sleep center" mills......just like a cow......and I can now fully understand why most people fail when it comes to CPAP therapy.

The cheap mask they gave me....and represented as "top-of-the-line"....bloodied the bridge of my nose.

Because I refuse to be "bovinely compliant", I wrote my own prescription (helped by what I learned from the nice people at CPAP.com), the doctor signed it, and I've never been back. I've educated myself with what I've learned on this forum......and from every book I could find that looked even reasonably good.

If you want to succeed, you need to "self-titrate" with an automatic machine that has full data reporting capability. "Compliance Data Only" is not acceptable....it relegates you to "livestock status". Get good software to go with your CPAP machine.....and if possible, get yourself a recording oximeter so that you can be sure that your CPAP machine is really doing its job.

Take charge of your own therapy.....it's the only way to go.

Gerald

Hi Slinky,

I am always pleased when you drop into my tent for a litl' visit. This time we can share COPD stories. Isn't fun, but mine is not as bad as yours.

I've read your previous views and sleep studies and the doctors who "herd us in" I share those views. I want to rely on my own information - I hope to be able to get a self-titrating machine. Is it only the auto's that have that feature?

In spite of you not always feeling as well as you would like, I always notice your posts, and replies to posts, (I can't add anything to the technical stuff - but I am learning from it.) forgive my analogy, but your willingness to help, reminds me of "Ol' Reliable" I'm not sure what Ol Reliable was, but she/it never slacked off, was always responsible, accurate, and has a fiesty spirit. I promise, I mean it as a compliment.

just call me Ol' Wheezy
Jan

Thank you, Jan. Yep, it is an autoPAP (APAP) that you want if you want or need to self-titrate. Forgive me if I've forgotten which xPAP you have now. If you go shopping for an APAP you "might" save yourself some money by buying the same brand's (and series) APAP so you can use your current integrated heated humidifier (if you have one). On the other hand, quite often the lightly used or even new APAPs at cpapauction.com often come complete wl/the integrated heated humidifier.