DO I NEED TWO SLEEP STUDIES?

[BoyertownCasket]

I have completed a sleep study ($3,000) and have obtained my results. In order for me to obtain a CPAP, I have been told I have to complete another sleep study for an additional $3,000.

Is this normal?

[kaiasgram]

I have completed a sleep study ($3,000) and have obtained my results. In order for me to obtain a CPAP, I have been told I have to complete another sleep study for an additional $3,000.

Is this normal?

Welcome to the forum. Yes, it's pretty normal, still standard practice at many medical centers. The second study is the titration study, where you sleep with a PAP machine and they try to find the right pressure that stops most or all of your apneas.

On the other hand, with straightforward cases of obstructive sleep apnea it's also possible to do the titration at home with an auto-adjusting CPAP (aka APAP) machine. This is how Kaiser Permanente routinely titrates patients newly diagnosed with sleep apnea. Except in rare complicated cases the patient never even sees a sleep doctor and everything is done at home. The data recorded by the APAP machine provides the basis for narrowing down the pressure(s). This is something we can do ourselves with some of the great available software.

So the second (titration) sleep study, while normal, is not always necessary and may be challenge-worthy. Do you have a copy of your sleep study report that you could post here (personal info whited out)?

[BoyertownCasket]

Thank you for your reply and the relevant information within. Yes, I will sanitize a copy and post it. Thanks again for your reply.

[BoyertownCasket]

Thank you for your reply and the relevant information within. Yes, I will sanitize a copy and post it. Thanks again for your reply.

This is a conventional polysomnographic study performed during the patient’s habitual sleep period in accordance with standards established by the American Academy of Sleep Medicine. Parameters include bilateral electrooculographic tracings; electroencephalographic tracings (modified 10-20 electrode configuration, featuring bilateral frontal, central and occipital leads); surface electromyography of submental musculature and bilateral anterior tibialis muscles; thoracic and abdominal respiratory impedance belt recordings; airflow measurements using oro-nasal thermister and nasal pressure transducer; electrocardiography; arterial oxygen hemoglobin saturation via finger pulse oximetry; and snoring. “Hypopnea” is defined by this center as a 30-70% decrease in airflow or respiratory effort lasting 10 seconds or longer in association with a 4% or greater oxygen desaturation.

Clinical Polysomnograpy Sleep efficiency was reduced at 62.5%. Out of 471.8 minutes in bed the patient slept for 295 minutes. Sleep architecture was abnormal. Sleep latency was normal at 29.5 minutes. There was 21.2% Stage N1, 66.4% Stage N2, 0% Stage N3, and 12.4% Stage R sleep. REM latency was prolonged at 218 minutes. There were 43.0 total awakenings during the night of less than 10 minutes and 0 awakenings which were greater than ten minutes in length. There were 2 REM periods. In addition to awakenings, there were 276.0 arousals from all causes for an arousal index of 56.1 per hour. Respiratory Parameters There were a total of 230 respiratory events (17 obstructive apneas, 132 hypopneas, 14 mixed apneas, 16 central apneas and 51 Respiratory Effort Related Arousals.) The Apnea-Hypopnea Index(AHI) was 36.4 events per hour and the Respiratory Disturbance Index(RDI) was 46.8 events per hour.

The longest event was 55.2 seconds in length and the average event was 17.7 seconds in length. In the supine position, the AHI was 89.8 events per hour. The patient was aroused 243 times due to respiratory events including snoring for a respiratory arousal index of 49.4 events/hour. Baseline O2 Saturation was 91.2. Nocturnal oxyhemoglobin saturation was normal . Minimum O2 Saturation was 84 %. In all, the patient spent 30.8 minutes with saturations below 89%. O2 Saturation Total Recorded (min) % of Recording 95% - 100% 12.0 2.5 90% - 94.9% 309.0 65.5 85% - 89.9% 145.1 30.7 80% - 84.9% 0.1 0.0 75% - 79.9% 0.0 0.0 70% - 74.9% 0.0 0.0 65% - 69.9% 0.0 0.0 60% - 64.9% 0.0 0.0 55% - 59.9% 0.0 0.0 50% - 54.9% 0.0 0.0 Time < 95% 454.1 96.3 Time < 90% 145.2 30.8 Moderate snoring was heard during the study.

Movement Analysis There were 103 total periodic limb movements during the sleep period for a PLM index of 20.9 events per hour. The patient was aroused 14 times due to PLMs for a PLM arousal index of 2.8 events/hour. Heart Rhythm Analysis The baseline heart rhythm was normal sinus. Also noted were occasional premature ventricular contractions Diagnosis and Impressions: 1. Severe Obstructive Sleep Apnea Syndrome – 780.53-0 2. Moderate Periodic Limb Movement Disorder – 780.52-4 3.

Nocturnal Arrhythmias Impressions and Treatment Recommendations:

1. Due to the severity of this patient's sleep apnea, the patient should be returned to the laboratory for a trial of Positive Airway Pressure Therapy.

2. Although Periodic Leg Movements were seen on this study, they are not causing significant sleep fragmentation or high numbers of arousals. Treatment of the patient’s periodic limb movement disorder is not recommended at this time.

3. Follow up in the Sleep Disorders Center to discuss the results of this study.

[trish6hundred]

Hi BoyertownCasket,
WELCOME! to the forum.
Hang in there for more answers to your questions and much success to you.

[BoyertownCasket]

Thank you dear one. Please take care of yourself too.

[kaiasgram]

Boyer, thanks for posting your sleep study. You know, you had a lot of things going on in that study including some mixed and central apneas, PLMs and numerous arousals. I'm inclined to say do get that second sleep study for several reasons: You might end up needing a bilevel machine to handle those RERAs and funky mixed and central apneas, and if so that might be documented by the second study. If you're susceptible to having even more centrals while on the machine they may be able to pick that up as well. Also, they'll be able to see if the PAP machine helps relieve the PLMD or if that issue might need to be treated separately.

Seems like you have a complex enough case that if you can afford it, it would be worth letting the pros titrate you.

I hope this helps.

[BoyertownCasket]

Boyer, thanks for posting your sleep study. You know, you had a lot of things going on in that study including some mixed and central apneas, PLMs and numerous arousals. I'm inclined to say do get that second sleep study for several reasons: You might end up needing a bilevel machine to handle those RERAs and funky mixed and central apneas, and if so that might be documented by the second study. If you're susceptible to having even more centrals while on the machine they may be able to pick that up as well. Also, they'll be able to see if the PAP machine helps relieve the PLMD or if that issue might need to be treated separately.

Seems like you have a complex enough case that if you can afford it, it would be worth letting the pros titrate you.

I hope this helps.

Thank you once again for an informative answer.

[kaiasgram]

Very welcome -- keep us posted.

[BoyertownCasket]

Very welcome -- keep us posted.

You are so kind. I will.