My Sleep Report

Just found this great website, and would love your inputs.
My sleeping pattern has been very messed up for the past decade, probably for various reasons. Anyway I finally had a sleep test done and while I do not think my apnea is that serious, I would still like to seek your advices as to whether I should use a CPAP machine or not.

A total of 86 snoring episodes (represented 12% of total sleep time), 4 obstructuve apnoea, 3 central aponea, and 7 hypopnoea episodes recorded. The longest apnoea and hypononea lasted 95 seconds and 23 seconds respectively. Overall Respiratory Disturbance Index was 2/hr and was higher during REM at 8/hr (normal <5hr). A few brief episodes of oxygen desaturation were recorded and the saturation dropped to a minimum of 88%. A few spontaneous EEG arousals were recorded and the overall arousal index was 21/hr.

This is all I got. Someone care to 'interpret' this?

So Lost,

Welcome to the world of OSA. Sounds like you will be using CPAP. Did you get a copy of your PSG? If so, what were your oxygen desats down to? The way you explained things, I'm not sure what your AHI was, but it seems that you had enough events to put you in the category of needing treatment.

Do you have any symptoms to speak of other than a "messed up sleeping pattern"? Are you tired, fatigued, any physical problems like increased blood pressure, headaches, or lack of ability to concentrate or think as well as you used to? You obviously snore, too. It seems from what you wrote, since you were shown to have some central apnea and respiratory apnea events, that you have the third type of OSA, which is a combination of the two other types. Some people have an anatomical obstruction of the airways, others have episodes that come from the brain technically shutting down breathing, and the third is a combo of the two.

Do you now have to go back for a titration study? Did they let you know that yet? I would presume so. That is the part where they will bring you back and put a CPAP mask on you and figure out what pressure will best either eliminate or greatly reduce your nightly episodes and keep your oxygen levels where they should be. Then when you get your own equipment, that will be the pressure they will set your home machine at.

You've come to a wonderful place, this site. It is, IMHO, an invaluable spot to find information, ask questions and to get the support you need from the members here, not to mention a place where you can just vent and blow off a little frustration if ever the need arises. Don't let this get you overwhelmed, although it's hard not to in the beginning when you are so tired and know so little about the condition. But you will learn so much here. All you have to do is ask. There is also a great "Search" button on the top where you can type in a subject and read previously posted threads on that topic which might explain what it is you were wondering about.

It's nice to meet you and welcome. Best of luck.

Sleepless on LI wrote:If so, what were your oxygen desats down to? The way you explained things, I'm not sure what your AHI was, but it seems that you had enough events to put you in the category of needing treatment.

Lori, if you reread his post you'll see his O2 sat dropped only to 88% and his RDI (which is usually higher than an AHI) was only 2 overall; 8 during REM.

My interpretation (not a doctor, and I haven't played at being one since I was a kid) is SoLost is borderline at best. This isn't to say he (?) wouldn't benefit from CPAP therapy, but the way I read it there is some other mechanism largely responsible for his arousals which are significant (21/hr).

Any other opinions?

Bill,
I must have misinterpreted the meaning of overall arousal rate. I thought somewhere along the lines, all the information was not being provided and that that represented his/her AHI, being 21. To me, that was high. However, 8 an hour in REM sleep? How can you get that if your AHI is 2? That didn't make sense to me. I took it to mean the 14 episodes that were identified were in NREM sleep. That to me meant the 2 AHI NREM and 8 REM, so it was an AHI of 10. I thought that meant treatment. I was a bit confused, though, with the overall rate of 21. You are right, the oxygen desats were only to 88%, which is not bad at all.

I guess I should just sit back and let others interpret these things from now on. Thought I understood what So Lost wrote to a certain extent to say it was enough at 10 AHI (or more/21) to need treatment, especially if it was an 8/hr in REM. My own AHI was 4 on my PSG, with no apnea, just hypops. It was my desats and PLMDs that put me over the top for needing treatment, though.

Thanks for clearing it up for So Lost.

And sorry, So Lost, for giving you what obviously is incorrect information.

Lori, no need to apologize to either me or SoLost. You might be right, I might be right, or it might be something else altogether. This is why the diagnosis has to come from a trained specialist. Plus we don't have all the data, but are just trying to interpret a summary.

The way I interpret the RDI (not AHI, similar but not meaning the same thing) as 8 in REM and overall (emphasis mine) as 2 is that almost all of SoLost's respiratory distrubances are clustered during the REM sleep. Of course, this is quite normal for obstructive sleep apnea (higher during REM).

If my interpretation is correct SoLost has very few apneic episodes and is showing only borderline desat (88% is just below the 90% line). However something is arousing him/her frequently (averaging every 3 minutes). This has got to be causing an abnormal/fragmented sleep architecture, leading to sleep deprivation and many of the same symptoms and physical, mental and emotional problems we have all had to deal with.

It'll be interesting to know what SoLost's doctor has to say and what the doc prescribes.

Overall Respiratory Disturbance Index was 2/hr and was higher during REM at 8/hr (normal <5hr).

This was my mistake, not yours. When I saw 8/hr and 2/hr in REM and NREM respectively, I took these to mean some type of apnea or hypopnea, being it was called a "respiratory" disturbance index. I felt perhaps that was another way of saying AHI, which would make it a 10 AHI, which from what I understood is definite for warranting therapy.

Like you say, Bill, we are not medical professionals and it will certainly be interesting to hear what So Lost's doctor has to say. I think, though, from now on, I'll leave these threads to people like Deltadave or even Rested Gal, WillSucceed or Ozij, who seem to have a great amount of knowledge about the intricasies of this condition.

My bad if it's not 10 AHI, but an RDI...whatever that could end up meaning.

PS: Bill, just looked up RDI and this is what it says:

Respiratory Disturbance Index (RDI)(Apnea/Hypopnea Index) - The frequency of abnormal respiratory events per hour of sleep. These events are classified as Apneas or Hypopneas. Apnea is when breathing (airflow) stops for 10 seconds or more. Hypopnea is a partial blockage of airflow resulting in arousal and a possible drop in oxygen level. An RDI of 45 would indicate that the patient is experiencing complete or partial airflow blockage 45 times per hour.

So maybe I was correct after all...this is the site I found this definition from
http://www.sleepquest.com/s_sleeptopics_r.html

here is my results directly from the report
Sleep Latency 18min 5-17 min
Sleep duration 380 min 330-420 min
Sleep Efficiency 89& 85-95%
Percent Stage 1 NREM 9% 4-12%
Percent Stage 2 NREM 26% 54-75%
Percent Stage 3 NREM 3% 0-7%
Precent Stage 4 NREM 21% 0-4%
Percent Stage REM 40% 18-27%
REM Sleep Latency 124min 50-122 min

Respitory airflow effort measures of the initial two hour of sleep revealed 147 events composed of 100 obstructive apneas and 47 obstructive hypopneas. These events ocurred with the patient on his side in Non-Rem sleep and were associated with severe oxegon desaturations with the low saturation of 52% and a mean saturation of 78%
sleep structure revealed REM and delta rebound following application of CPAP. During the night, 184 arousals were reported with 174 due to respitory events, and 10 due to unknown reasons.

I will need to write a book about this there are over 15 pages

Patrick,

I think it's safe to assume you're either on therapy already or are going on it? If you're already on it, hope you're doing well and feeling better. If not, best of luck and keep us posted.

Patrick A wrote:

I have been on it since June 22,2005 feel like I could do cartwheels from Mexican Border to the Canadian Border. Never was able to sleep longer than 2 or 3 hrs. everyday now I am sleepin in my bed almost 7 to 9 hrs aday instead of sleeping in my chair all the time

Amen!!!

Sleepless on LI wrote:PS: Bill, just looked up RDI and this is what it says:

Respiratory Disturbance Index (RDI)(Apnea/Hypopnea Index) - The frequency of abnormal respiratory events per hour of sleep. These events are classified as Apneas or Hypopneas. Apnea is when breathing (airflow) stops for 10 seconds or more. Hypopnea is a partial blockage of airflow resulting in arousal and a possible drop in oxygen level. An RDI of 45 would indicate that the patient is experiencing complete or partial airflow blockage 45 times per hour.

So maybe I was correct after all...this is the site I found this definition from
http://www.sleepquest.com/s_sleeptopics_r.html

From this site's own CPAPopedia:

RDI Acronym: Respiratory Disturbance Index

Includes apneas and hypopneas, and may also include other respiratory disturbances such as snoring arousals, hypoventilation episodes, desaturation events, etc. They are often identical, but depending upon what is scored, the RDI may be larger than the AHI.

So, if correct, RDI may be higher than AHI, or it might be exactly the same thing. Who knows?

Bill,
Now I'm worried about myself. The first place I looked for the definition of an RDI was this site's encyclopedia and didn't find it. But the entires on this site are given by members. Whether they are correct or not, I don't know.

In any event, I suggest we just wait and see what ends up happening with So Lost as I'm sure there are other pieces to the puzzle we don't know about, too.

So Lost, I think I can safely speak for Bill AND myself when I say we don't mean to talk about you like you're not here...just trying to figure out whether what we thought is so or not.
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Bill, I just found it under RDI, instead of Respiratory Disturbance Index, and it's Johnny's definition, so it's probably pretty acurate. But funny how the site I listed and his definition differ. No?
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Sleepless on LI wrote:But funny how the site I listed and his definition differ. No?

Actually from what I've read and been told, that isn't so strange. RDI is a poorly defined metric that could mean whatever the person doing the interpretation wants it to mean it seems. This is piled on top of the question of what is a respiratory disturbance anyway? How much occlusion must occur before a breath is considered a hypopnea? And how long must a breath be delayed before it is an apnea? And how loud must an accoustic vibration be to be a snore?

How many angels can dance on the head of a pin? First I must ask what size pin and what type of angel? (It is clear there is more than one kind.)

SoLost, like Lori I'm not trying to ignore you. I'm just trying to point out that your results are open to interpretation, but the only interpretation that will really matter to you is your doctor's.

Still, I hope we've helped increase your understanding. And maybe entertained you along the way .

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CPAPopedia Keywords Contained In This Post (Click For Definition): RDI, Hypopnea

WAFlowers wrote:How many angels can dance on the head of a pin? First I must ask what size pin and what type of angel? (It is clear there is more than one kind.)

No, not necessary. The answer is, 27 angels. And the size of the pin is irrelevant. Yes, I do know everything (actually, only the really important stuff).

Hi guys!
WAFlowers, you got it right:

AHI is exactly that, apnea-hypopnea index.
RDI is AHI+RERAs+snore arousals.

There's been confusion re: these definitions as long as I can remember. And still is. And don't even get me started on hypopneas.

deltadave