What follows is the main part of my sleep study:
Protocol: This sleep study included the recording and monitoring of frontal, central, and occipital EEG, EOG, EMG, ECG, respiratory effort and flow, snoring, pulse oximetry, and position. Video recordings were obtained as needed. A qualified technician continually monitored patient throughout the night. Data was digitally stored and tabulated using Alice 5 software. Sleep staging and respiratory events were scored manually using AASM standards.
Sleep Latency: The patient’s sleep onset latency after lights out was 22.5 minutes. The Stage R sleep latency from sleep onset was 110.0 minutes.
Total Sleep Time: The total time in bed was 376.0 minutes with a total sleep time of 244.5 minutes. Sleep efficiency was 65.0 %.
Sleep Architecture: The patient had 41.0 minutes of Stage R for 16.8% of TST, 37.0 minutes of Stage N1 for 15.1% of TST, 166.5 minutes of Stage N2 for 68.1% of TST, and 0.0 minutes of Stage N3 for 0.0% of TST. The arousal index was 5.4 per hour of sleep.
Respiratory: The patient was observed to have had a total number of 188 apneas and hypopneas with an AHI index of 46.1 per hour during total sleep time. The Stage R AHI index was 55.6. The normal AHI index is less than 5 per hour. There were 10 obstructive apneas, 0 mixed apneas, 60 central apneas, 118 hypopneas (4% desaturation or greater), 0 central hypopneas, 0 obstructive hypopneas and 5 RERA’s. The total RDI (A/H + RERA’s) was 47.4. Mild snoring was noted for 28.6% of TST. A split-night was not conducted due to physician order stating PSG.
Oxygenation: The patient had an average oxygen saturation of 95%. The minimum oxygen level was 83%. *Masimo Pulse Oximeters are accurate to a low SpO2 of 70% (+,-3).
Cardiac: The average heart rate was 55.6 beats per minute. The patient had a normal sinus rhythm with no arrhythmias noted.
Other/EMG: Patient had evidence of periodic leg movements during sleep. Patient had a total of 93 PLM’s with a PLM index of 22.8 and a total of 14 PLM arousals with a PLM arousal index of 3.4 per hour of sleep.
Diagnosis:
Severe obstructive sleep apnea (G47.33) with an overall AHI of 46.
Nocturnal hypoxia (G47.36).
Abnormal sleep architecture with evidence of reduced of delta sleep.
Patient did not qualify for split night (CPAP trial) protocol.
There were significant periodic limb movements (G47.61) with a PLM index of 23.
Recommendations:
Treatment for Obstructive Sleep Apnea is indicated to prevent cardiovascular morbidity and effects on daytime performance. Treatment options include CPAP/BiPAP, dental sleep appliances, upper airway surgery and neuro-stimulation.
Until successful treatment has been established patient should be advised of the risk of driving or operating heavy machinery.
Conservative therapy may also be helpful including weight loss, avoiding alcohol or sedatives prior to sleep, cool and totally dark bedroom, and trying to maintain a regular sleep pattern.
Patient should return for a full night CPAP/BiPAP titration to optimize pressure settings if patient elects to have PAP therapy. Auto-PAP device set at 6-20 cwp should be considered while awaiting definitive titration or as an alternative to CPAP.
Further evaluation and treatment of Periodic Limb Movements should be considered if they continue to cause arousals despite successful treatment of the obstructive component of the patients sleep disorder.
