[Diagnosis] Sleep Study Results - Please provide your thoughts

[nickaq]

I would appreciate people that have been through a sleep study and have found relief to review my results and provide any feedback as to how bad of shape I am in.

My symptoms are fatigue, severe body/muscle pain, blurry vision, frequent urination or sensation to urinate at night, daytime sleepiness, lack of concentration and the list goes on and on... :-D

Main complaint: Trouble sleeping at night.
Medications: See list in the file.
Epworth Sleepiness Scale: 2 (A score of ≥ 10 signifies excessive sleepiness)
PHQ-9 Score: 17 (normal less than 5)
PHYSIOLOGICAL PARAMETERS MEASURED
X Left and Right EOG X EKG
X Chin EMG X Anterior Tibialis EMG
X Abdominal Movement X Thoracic Chest Movement
X Nasal and Buccal Airflow/PTAF X Oximetry
X EEG (F4-M1, C4-M1 and O2-M1) X Snore Sound
PARAMETRIC ANALYSIS
EKG: Normal sinus rhythm.
HEART RATE: 61 bpm average. Highest during sleep: 52 bpm. Highest of awake: 68 bpm.
LEG EMG: PLMs spaced 20-40 seconds apart. Total PLMs: 29. Total PLMs with arousals: 2. PLM index:
5/hr. arousal index: 0/hr.
CHIN EMG: Normal
EEG: Unremarkable
EOG: Normal

SLEEP ARCHITECTURE:

Sleep Stages
1. Total time in bed: 372 minutes (6.2 hrs)
2. Total sleep time: 346 minutes (5.8 hrs)
3. Sleep Efficiency Index: 93%
4. Wake time: 26 minutes (Normal is equal or less than 20 minutes)
Stage N1: 65 minutes (19% of total sleep time. Normal: 5-15%)
Stage N2: 236 minutes (68% of total sleep time. Normal: 45-80%)
Stage N3: 0 minute(s) (0% of total sleep time. Normal: 0-15%)
REM sleep: 45 minutes (13% of total sleep time. Normal: 12-20%)
5. Latency to sleep onset: 12 minutes (Normal 10-20 minutes)
6. Wake after sleep onset: 14 minutes (Normal is equal or less than 20 minutes)
7. Latency to REM onset: 112 minutes (Normal is equal or greater than 90 minutes)
8. Number of REM period(s): 3
9. Total number of arousals: 131 Arousal index: 23/hr (Normal is less than 10/hr)

Patient's Description of Sleep: The patient estimated that it took 60 minutes to fall asleep and awakened 2
times during the night. The patient estimated sleep time in the study was about 4 hours. The patient felt sleep
last night was the same as it usually is at home and described their sleep as being light, interrupted, restless,
short, and dreamless. Upon awakening the patient felt a little foggy and let down.

Lights Out: 11:19PM Lights On: 5:31 AM Sleep onset at 11:31 PM and time of final awakening at 5:31 AM.

RESPIRATION
Respiratory Rate: 14-16 breaths per minute.
Obstructive apneic events lasting over 10-56 seconds together with snore arousals caused sleep disturbance.
The associated oxygen desaturations were moderated. The patient did not have Cheyne Stokes breathing.
During baseline study: Total obstructive apneas: 30. Total central apneas: 0. Total mixed apneas: 2. Total
hypopneas: 35. Total number of apneas/hypopneas: 67. Total number of RERAs: 27.

Position (S=supine, L=Lateral)-----------------------------S, L
Sleep State (R=REM; N=NREM)--------------------------R, N
Baseline SaO2 Level (%)------------------------------------95-96%
Minimum O2 Saturation (%)-------------------------------85%
Recorded Sleep Time (Hours)------------------------------5.8
AHI-------------------------------------------------------------12/hr
RDI-------------------------------------------------------------16/hr
AHI on supine position--------------------------------------11/hr
AHI during REM sleep--------------------------------------42/hr

Apnea/Hypopneas Index (AHI): Number of apnea/hypopnea episodes per hour of sleep (Normal equal or than
5).
Hypopnea definition VIII.4.A: A decrease in the nasal pressure signal amplitude of 30% or greater, lasting 10 or
more seconds, with a 4% or greater oxygen desaturation from baseline, with 90% of the event's duration
meeting the amplitude reduction.
Respiratory Disturbance Index (RDI): Number of apnea, hypopnea, and respiratory effort related arousal
(RERA) episodes per hour of sleep.

INTERPRETATION
I have reviewed the referral request, physician-obtained patient history and medical notes, patients sleep
questionnaire and sleep technologist's notes.
Impression: This is an abnormal nocturnal polysomnogram. The patient slept 5.8 hrs out of a total 6.2 hrs
bedtime monitored, yielding a sleep efficiency of 93%. Latency to sleep onset was at 12 minutes, which was
within the normal range. The arousal index was abnormally elevated. The study demonstrates obstructive
sleep apnea, worse during REM sleep and associated with oxygen desaturation down to 85% from baseline of
95-96%. EKG, EEG, and EMG were normal.

Diagnosis: Axis I: Obstructive Sleep Apnea (327.23). Axis II: Nocturnal Polysomnogram baseline study, 95810.
Split night protocol, allowing for both diagnosis and therapy with CPAP, was attempted, but the patient did not
meet the diagnosis of OSA until the end of the study. Insufficient time was therefore available to begin therapy
with CPAP.

Recommendations:
1) Consider treatment with CPAP. Treatment options will be discussed with the patient during follow up..
2) Patient has possible mild-moderate depression given elevated PHQ-9 score.
3) Mild increase in PLMS. Clinical correlation advised.
4) Patient should try to maintain set bed and wake times. If the patient does not meet sleep needs at
night, afternoon naps should be taken to supplement.
5) Weight loss may improve the degree of sleep disordered breathing.
6) The patient should be advised not to drive when sleepy.

Thanks!

[RonWessels]

Let me first start by saying that I am not a doctor. However, I can give you my opinion, for what it's worth.

No N3 sleep, eh? Well, that would explain the fatigue and run-down feeling.

It appears that you have mild to moderate obstructive sleep apnea, becoming severe during REM sleep. Overall, it doesn't seem that bad. You should definitely consider CPAP therapy. I suspect it will help you out immensely. I also think that you should hold off trying to address your possible mild-moderate depression until you are well entrenched in your CPAP treatment. I found personally that my mood improved considerably once I was no longer a walking zombie.

The next stage will be between you and your doctor. But I see two possible courses of action. Firstly, if you are technically inclined and/or motivated to have an active hand in your own treatment, your doctor might send you home with an Auto-CPAP machine. This machine will automatically determine the correct pressure to use for your treatment during the night. You will then probably have to return with the collected data from the machine to determine your final treatment methodology. Alternatively, if you want to be more passive in your treatment, you will have to return for another sleep study where they hook you up to a remote-controlled CPAP machine and determine for themselves what CPAP pressure will successfully treat your condition.

Depending on your treatment pressure requirements, you will then be prescribed either a fixed-pressure CPAP machine or an auto-CPAP machine for you to use every time you sleep.

[nickaq]

Hi Ron,

Thank you for responding. I do agree, CPAP has to be attempted, because honestly, I feel like I am dying a slow death. It is really terrible! My O2 during sleep seemed bad as well, would you agree?

[jgjones1972]

Agree with RonWessels.

No Non REM stage 3 sleep is hard on you - something needs to be done to correct that.

PAP is likely that thing...I'm not a doctor either, but sure looks to me like a pretty sure fire case of OSA.

[Tez62]

Nickag, welcome, not even looking at your results, just from your symptoms they are typical SA symptoms, the depression symptoms and the feeling of a slow death were exactly what I was going through prior to starting CPAP. I also have PLMS, period limb movement disorder, where you limbs move or kick during the night, this will also lead to some of your tiredness. On a positive side all my symptoms lifted after about 3-6 months of treatment and after 2 years feel great and love life. Get onto your CPAP ASAP and use it every single time you sleep, keep us updated.

[trish6hundred]

Hi nickaq,
WELCOME! to the forum.!
I agree with what has been said so far.
Hang in there for more responses to your post and best of luck.

[RonWessels]

Nickaq, with regards to your SpO2 values, you might be surprised to find out that a minimum of 85% is not even close to the worst I've seen. Yes, it means you have sleep apnea that affects your SpO2, but, for example, mine went down to below 80% in my sleep study. [ Of course, my untreated AHI was over 100. ] And I've heard of people with even lower than that.

I guess for stuff like this, it's actually good to be "mediocre". It certainly beats the heck out of "OMG, how are you still alive?!!"

Now, don't let my comments that you are not on death's doorstep dissuade you from getting treatment NOW. This is a serious condition and it does not get better by itself. I ignored my condition for more years than I would care to admit. And surprise, guess what? I now have heart arrhythmia with frequent PVC's and PAC's. I've had a full cardiac workup, and the good news is that there is nothing fundamentally wrong with me, so I just suck it up and deal with the palpitations when they happen.

[nickaq]

You are all so helpful! It is good to know I am not alone or crazy! I am sitting at UCLA right now waiting to discuss the results and hopefully, treatment options!

Nick

[Tez62]

You are all so helpful! It is good to know I am not alone or crazy! I am sitting at UCLA right now waiting to discuss the results and hopefully, treatment options!

Nick

Nick, if you decide on CPAP. which you should, ask for an APAP or Auto CPAP, the most popular is probably a Resmed S9 Autoset or a Phillips. Don't get the basic machine in the range, they are cheaper but not data capable.

[DocWils]

Nick, your file pretty much describes a decent case of OSA, and for that two things are recommended together - weight loss and CPAP, probably an auto PAP would be best for you. If that allows you to descend into a normal sleep pattern (it won't right away, so give it time) you will be felling better quickly. However I also suggest you revise your sleep hygiene (look elsewhere on this forum for discussion of that and some tips and tricks). Good luck.