Newbie with sleep study results and questions

[Masta]

Hello All

I've had an overnight sleep study done in a sleep lab 3 weeks ago. I went back for the results two weeks ago. I was told I have mild OSA. I'll post the results below.

Some background history:
In 2008 I had an overnight pulse oximetry test done which suggested c-pap was the most effective form of treatment and other conservative treatments are worth looking into, which were: weight loss, hypothyroidism, avoiding supine sleep, and nasal obstruction. I'm now medicated for hypothyroidism, and I have had my septum repaired in 2012. Lowest Sp02 was 90% and Desaturation index was 1.2 per hour. I didnt sleep well wearing the pulse oximetry device that night.

I was recently diagnosed with tachycardia and chest pain. Heart problems run in my family. Had a Cardiac Stress Test MRI done two weeks ago. Cardiologist says my heart is fine. I was placed on medication for the tachycardia a week before the sleep study. The night of the overnight sleep study I took my heart/tachycardia medication, a muscle relaxer, and an prescription NSAID right before I fell asleep (I have multiple spine issues and seeing pain management for it).

I wish I knew how to upload a scanned picture attachment of my test scores. I'Il type them below.

Female: 42yr old
Sleep Study: it says split night? I wasnt given c-pap and I havent been back for another study
Neck: 15 in
Nose and throat: doctor said my nose airway was a level 2, slim. My tonsils and adenoids are large.
Suffer from: tmj, asthma, tachycardia (new diagnosis), hypothyroidism, migraines, morning headaches, adrenal insufficiency, dizziness and light headiness, tinnitus- ear surgery, poor inner ear pressure and conductive hearing loss, moderate anxiety, depression and currently in pain management and refusing to start narcotics for multiple spine problems.

Results of my overnight sleep study

Sleep Study Overview
First Lights Off: 11:36:56 pm
First Lights on: 5:59:14 am
Time in bed: 382.3
Total Sleep Time: 210.5
Sleep Efficiency: 55.1%
Sleep Period Time: 351.0
Sleep Maintenance Efficiency: 60%
Sleep Latency: 11.7
WASO: 160.1
PLM Index: 24.8
REM Latency from Sleep Onset: 0
Awakenings: Count 15, Index 4.3
Arousals: Count 67, Index 19.1
Apneas and Hypopneas: Count 18, Index 5.1
Limb Movements: Count 161, Index 45.9
Snores: Count 8, Index 0.00
Sleep Onset Time: 11:48:36pm
Desaturations: Count 14, Index 4.1
Average Oxygen Saturation: Count 95%

Sleep Architecture
Stages
Wake: 171.8 mins, 44.9% sleep time
Stage N1: 151.5 mins, 72.0% sleep time
Stage N2: 36.5 mins, 17.3% sleep time
Stage N3: 22.5 mins, 10.7% sleep time
REM: 0.0% mins, 0% sleep time
Movement: 0.0mins, 0.0% sleep time

Arousal Summary
Respiratory: 0 REM, 6 NREM, 9 Arousals, 5 Awakenings, 14 Ar + Aw, 4.0 Ar + Aw Index

Leg Movements: 0 REM, 24 NREM, 29 Arousals, 5 Awakenings, 34 Ar + Aw, 9.7 Ar + Aw Index

Snore: 0 REM, 0 NREM, 0 Arousals, 0 Awakenings, 0 Ar + Aw, 0 Ar = Aw Index

Spontaneous: 0 REM, 26 NREM, 29 Arousals, 5 Awakenings, 34 Ar + Aw, 9.7 Ar = Aw Index

Total: 0 REM, 56 NREM, 67 Arousals, 15 Awakenings, 82 Ar + Aw, 23.4 Ar = Aw Index

Arousal Index: 0.0 REM, 16.0 NREM, 19.1 Arousals, 4.3 Awakenings, 23.4 Ar + Aw

Respiratory Summary
Sleep Time: 210.5 NREM, 0.0 REM, 25.7 Supine, 184.80 Non-Supine, 210.5 Total

Obstructive Apnea: 0 NREM, 0 REM,0 Supine, 0 Non-Supine, 0 Total

Mixed Apnea: 0 NREM, 0 REM, 0 Supine, 4.55 Non-Supine, 0 Total

Central Apnea: 1 NREM, 0 REM, 0 Supine, 1 Non-Supine, 1 Total

Total Apnea: 1 NREM, 0 REM, 0 Supine,1 Non-Supine, 1 Total

Obstructive Hypopnea: 0 NREM, 0 REM, 0 Supine, 0 Non-Supine, 0 Total

Central Hypopnea: 0 NREM, 0 REM, 0 Supine, 0 Non-Supine, 0 Total

Total Hypopnea: 17 NREM, 0 REM, 4 Supine, 13.00 Non-Supine, 17 Total

Total Hypopnea Index: 4.8 NREM, 0 REM, 9.3 Supine, 3.71 Non-Supine, 4.8 Total

All Apneas & Hypopneas: 18 NREM, 0 REM, 4 Supine, 14.00 Non-Supine, 18 Total

AHI: 5.1 NREM, 0 REM, 9.3 Supine, 4.55 Non-Supine, 5.1 Total

Cheyne Stokes: 0 NREM, 0 REM, 0 Supine, 0 Non-Supine, 0 Total

RERAs: 6 NREM, 0 REM, 0 Supine, 6.00 Non-Supine, 6 Total

RERA Index: 1.7 NREM, 0 REM, 0 Supine, 1.71 Non-Supine, 1.7 Total

RDI: 6.8 NREM, 0 REM, 9.3 Supine, 5.70 Non-Supine, 6.8 Total

Respiratory Event Durations
Average (Seconds): Apnea - NREM 11.0, REM 0, Hypopneas - 19.6 NREM, 0 REM
Maximum (Seconds): Apnea - NREM 11.0, REM 0, Hypopneas - 30.0 NREM, 0 REM

Oxygen Saturation Summary
Average OSat %: 95% Wake, 95% NREM, -- REM, 95% Total
Minimum OSat %: -- Wake, -- NREM, -- REM, 82% Total

# Of Desaturations: 14
Minimum Oxygen Saturation During Desaturations: 84%
Time Less than 88: 12.1 minutes

Limb Movement Summary
Total Leg Movement: 161 Count, 45.9 Index (#/h)
PLMS: 87 Count, 24.8 Index (#/h)
PMLS Arousal: 16 Count, 4.6 Index (#/h)

Cardiac Summary
Average Pulse Rate During Sleep (TST): 78.2 bpm
Highest Pulse Rate During Sleep (TST): 98 bpm
Highest Pulse Rate During Recording (TIB): 104 bpm

Sleep study comments: A baseline study was ordered and completed. The patient had low oxygen for the majority of the night. She had mild respiratory events. She had moderate sleep fragmentation and poor sleep efficiency (55.1%).

My full report with recommendations:

Polysomnogram:
Sleep quality: The sleep onset was 11.7 minutes normal being 10-30 minutes. She slept for a total of 210.5 minutes out of a possible 382.3 minutes, resulting in a sleep efficiency of 55.1%, normal being greater than 90 percent. The awake time after sleep onset (WASO) was 160.1 minutes. She had mild sleep fragmentation. She had 67 arousals during the night, resulting in an arousal index of 19.1 arousals/ hour of sleep. Most of these arousals were caused by limb movements. She also had frequent periods of prolonged wakefulness.

Assessment: Obstructive sleep apnea. This patient had mild sleep apnea. Her AHI was 5.1 events/hour and her Sp 02 dropped to as low as 82%. Her AHI worsened to 9.3 events/hour while sleeping in the supine position, compared to only 4.5 events/hour when sleeping in the non supine position. Her sleep apnea contributed to sleep fragmentation, her arousal index was 19.1 arousals/hour of sleep. A split night study was not possible, according to our protocol, as she did not demonstrate moderate to severe apnea prior to 2am.

Periodic limb movement disorder: This patient had 191 limb movements during sleep, which led to 34 arousals. The periodic limb movement index was 24.8 limb movements/hour.

Decreased REM sleep: This patient was unable to obtain any REM sleep. where it is normal to spend between 20-25% of sleep time. This can be caused by anything that interrupts or fragments sleep such as pain or sleep apnea, but it also can be caused by medications, most commonly anti-depressants/psychoactive drugs.

Decreased sleep efficiency: This patient slept for only 55.1% of the available study time. It is normal to sleep greater than 90% of the study. It is not uncommon for patients to struggle during their first night in the sleep lab.

**Recommendations**:
Obstructive sleep apnea. This patient has mild sleep apnea and DOES qualify for CPAP treatment, however, a more conservative approach could be pursued. Often simply avoiding sleeping in the supine position while maximizing nasal airflow is very effective. using a mandibular advancement device may also be effective. Aggressive weight loss is usually effective if the patient has gained weight in the face and the neck. These options should be discussed with the patient. "Could be pursued". I've been a walking zombie for over 10yrs, I dont want to try alternatives to cpap at this point. I have tmj so I dont want to deal with a mouth device. I have spine issues, so if i do sleep on my back it isnt for long, I already try to avoid it.[/color]

Periodic limb movement disorder: This patient’s limb movement disorder should be treated only if her excessive daytime sleepiness does not improve with the treatment of her sleep apnea. My limb movement disorder was not discussed at all, or treated.

Decreased REM sleep: This will hopefully improve with the treatment of her underlying breathing disorder. An evaluation for nocturnal pain or discomfort would be helpful. Adjusting any centrally active medications may also be helpful. No evaluation for nocturnal pain or discomfort was suggested or done.

Decreased sleep efficiency: If this patient does have regular struggles with insomnia, it is important to improve sleep hygiene, control of pain or discomfort, and treat any underlying anxiety disorder. I do suffer with insomnia, sleep hygiene, control of pain etc was not mentioned during my consult.

My sleep doctors signature is on this report, but he didnt follow through with the recommendations.

The sleep doctor was aware of the tachycardia diagnosis during my 2nd visit, while receiving the sleep study results. He said the sleep test showed I didnt get enough sleep and no rem sleep, he also said my hypopneas would have been higher if I would have gotten REM sleep, therefore the AHI number would have been higher too. He pretty much ignored the sleep test data, saying that the low minimum oxygen saturation was the finger monitor not getting an accurate reading because I rolled over during the night. He said to avoid sleeping on my back. I already do because of my spine issues.

The sleep doctor placed me on 50mg Trazadone for 3 weeks until our next visit (take 1/2 -1 tablet every night). I started off taking half a tab - 25mg at night, woke up very groggy, had a good 8hrs sleep (i rarely get 6hrs a night sleep). after 4 days the pill stopped working, I took a full tablet, it hasnt helped with my sleep. The sleep doctor said he might do a overnight pulse oximetry test. He said I do not need a c-pap machine, nor do I need to repeat the overnight sleep study. He said he tries to get people with higher AHI scores down to my scores. He did not address the PMLS at all. He did not address my high "arousal index" and higher "spontaneous arousal" index. I have fired this doctor. I have a new appt with a new doctor in 3 weeks. Im keeping a sleep journal. I want to be prepared for this appointment.

I have been waking up exhausted everyday for over 10yrs. The exhaustion is at a new time high, over the last 6 weeks. Im experiencing dizziness/light headinesses on top of exhaustion. I have purchased a wrist pulse oximeter CMS- 50F to monitor my own desaturations before my next doctors visit.

I have 3 days worth of pulse ox readings. I dont know how to upload here so I can get some input from the board.

[richb]

See what your new Dr has to say. You are borderline for needing a CPAP type machine. Maybe you could explore getting a "loaner" machine to see if your overall sleep quality improves. Pain can interfere with sleep but you have to be very careful with pain medications even those prescribed by Drs.

[trish6hundred]

Hi Masta,
WELCOME! to the forum.!
Hopefully your new sleep doc will be able to give you better guidance and be more attentive to your needs.
Much success to you and good luck at your next apointment with your new sleep doc.
Hang in there for more answers to your question.

[tedburnsIII]

Curious as to OP Avg. Low Sp02 for each of the three nights, and her basal Sp02's and number of Sp02 events for each of the nights.

[Masta]

Thank you for your replies and welcome

I received the CMS-50F pulse ox last week from Cooper Med

Three night studies below
Night One
Date: 06/27/15
Time Length Recorded: 05:32:13

Event Data ---- Sp02---- PR
Total Event:----- 57---- 55
Time In Event (min):---- 28.9---- 23.5
Avg. Event Dur. (sec):---- 30.4---- 25.7
Index (1/hr):---- 10.9---- 10.6
Artifact (%):---- 0.2---- 0.2
Adjusted Index (1/hr):---- 11.0---- 10.6

Sp02 Data
Basal Sp02 (%): 94.3
Time (min) <88%: 0.2
Events <88%: 1
Minimum Sp02 (%): 84
Avg. Low Sp02 (%): 92.3
Avg. Low Sp02 <88%: 84.0

PR Data
Avg Pulse Rate (bpm): 73.9
Low Pulse Rate (bpm): 62

%Sp02 Level---- Events---- Below (%)---- Time (%)
99-95:---- 3---- 100---- 100
94-90:---- 53---- 95---- 61.7
89-85:---- 0---- 90---- 0.1
84-80:---- 1---- 85---- 0.0
79-75:---- 0---- 80---- 0.0
74-70:---- 0---- 75---- 0.0
69-65:---- 0---- 70---- 0.0
64-60:---- 0---- 65---- 0.0

Analysis Parameters
Desaturation Event: drop n Sp02 by at least 4%, for a minimum duration of 10 seconds.
PR Event: Change in rate by at least 6 bpm, for a minimum duration of 8 seconds.

Night 2
Date: 06/28/15
Time Length Recorded: 08:07:56

Event Data---- Sp02---- PR
Total Event:---- 125---- 85
Time In Event (min):---- 63.9---- 40.4
Avg. Event Dur. (sec):--- 30.7---- 28.5
Index (1/hr):---- 15.4---- 10.5
Artifact (%):---- 0.3---- 0.3
Adjusted Index (1/hr):---- 15.4---- 10.5

Sp02 Data
Basal Sp02 (%): 93.5
Time (min) <88%: 0.6
Events <88%: 4
Minimum Sp02 (%): 84
Avg. Low Sp02 (%): 90.9
Avg. Low Sp02 <88%: 86.0

PR Data
Avg Pulse Rate (bpm): 74.1
Low Pulse Rate (bpm): 59

%Sp02 Level---- Events---- Below (%)---- Time (%)
99-95:---- 0---- 100---- 100
94-90:---- 99---- 95---- 76.9
89-85:---- 25---- 90---- 1.2
84-80:---- 1---- 85---- 0.0
79-75:---- 0---- 80---- 0.0
74-70:---- 0---- 75---- 0.0
69-65:---- 0---- 70---- 0.0
64-60:---- 0---- 65---- 0.0

Analysis Parameters
Desaturation Event: drop n Sp02 by at least 4%, for a minimum duration of 10 seconds.
PR Event: Change in rate by at least 6 bpm, for a minimum duration of 8 seconds.

Night Three
Date: 06/29/15
Time Length Recorded: 08:17:37

Event Data---- Sp02---- PR
Total Event:---- 146---- 81
Time In Event (min):---- 72.1---- 47.3
Avg. Event Dur. (sec):---- 29.6---- 35.0
Index (1/hr):---- 17.6---- 9.8
Artifact (%):---- 0.3---- 0.3
Adjusted Index (1/hr):---- 17.7---- 9.8

Sp02 Data
Basal Sp02 (%): 93.8
Time (min) <88%: 3.1
Events <88%: 2
Minimum Sp02 (%): 76
Avg. Low Sp02 (%): 91.5
Avg. Low Sp02 <88%: 87.0

PR Data
Avg Pulse Rate (bpm): 73.9
Low Pulse Rate (bpm): 51

%Sp02 Level---- Events---- Below (%)---- Time (%)
99-95:---- 2---- 100---- 100
94-90:---- 131---- 95---- 73.9
89-85:---- 13---- 90---- 1.0
84-80:---- 1---- 85---- 0.6
79-75:---- 0---- 80---- 0.2
74-70:---- 0---- 75---- 0.0
69-65:---- 0---- 70---- 0.0
64-60:---- 0---- 65---- 0.0

Analysis Parameters
Desaturation Event: drop n Sp02 by at least 4%, for a minimum duration of 10 seconds.
PR Event: Change in rate by at least 6 bpm, for a minimum duration of 8 seconds.

I dont know what I should be looking for exactly with these reports?

[zonk]

I'm not an expert, but my understanding arousals (RERAs) do not meet the definition of apnea and not included in AHI
But nevertheless do disrupt your sleep and prevent you getting into deeper sleep stages which is restorative sleep, hence waking up feeling refreshed

AHI 5.1 might be considered mild OSA, but if "arousal index" (RDI) 19.1 taken into account, that put you in moderate OSA category

According to a study: http://emedicine.medscape.com/article/29...fferential
[One study found that 30% of symptomatic patients would have been left untreated if the AHI were used rather the RDI]

If were me, I would definitely try CPAP. Putting anything inside the mouth, make me gag

ResMed AirSesne 10 AutoSet for Her have a mode (for Her) designed for women in mind

[tedburnsIII]

I'm not an expert, but my understanding arousals (RERAs) do not meet the definition of apnea and not included in AHI
But nevertheless do disrupt your sleep and prevent you getting into deeper sleep stages which is restorative sleep, hence waking up feeling refreshed

AHI 5.1 might be considered mild OSA, but if "arousal index" (RDI) 19.1 taken into account, that put you in moderate OSA category

According to a study: http://emedicine.medscape.com/article/29...fferential
[One study found that 30% of symptomatic patients would have been left untreated if the AHI were used rather the RDI]

If were me, I would definitely try CPAP. Putting anything inside the mouth, make me gag

ResMed AirSesne 10 AutoSet for Her have a mode (for Her) designed for women in mind

RDI, if higher than AHI, predominates as the determining factor for severity of condition.

But her final RDI for the study was only 6.8, is that correct?

If her study were split-night as stated, she should've spent half the night in a titration with CPAP.

Also, it seems there were many desats during her 3 recent overnight oximetry tests. I've managed to get my desats down to 5 to 10 a night using straight CPAP:

[Masta]

RDI, if higher than AHI, predominates as the determining factor for severity of condition.

But her final RDI for the study was only 6.8, is that correct?

If her study were split-night as stated, she should've spent half the night in a titration with CPAP.

tedburnsIII: my report says a split night study was not possible, according to their protocol, as I did not demonstrate moderate to severe apnea prior to 2am.

Yes my RDI is 6.8. my arousal index was 19.1 arousals/hour of sleep.

How do you attach your pulse ox report in a message?

Can anyone give me some input on PLMD? what is a normal number?

[tedburnsIII]

If I am not mistaken, 20-22 arousals an hour is considered normal. What is 'normal' is age-dependent, from what I have read. The figures cited by one source state that 20-22 arousals are normal for people who are 50-60 years old.

If you don't feel good during the day, don't feel that you sleep well, have morning headaches or feel fatigued, want to close your eyes or want to nap during the day, then you should seriously consider going along with the program. You have little to lose even though your case is apparently mild, and your overnight ox reports appear not too bad at all.

[tedburnsIII]

How do you attach your pulse ox report in a message?

Suggest that you Google "Need help in embedding pdf files here" which not only applies to pdf files but also to oximetry reports. On my Google Search it's the fourth one down. 'yaconsult' helped me a lot in that thread.

The key is to use 'Snipping Tool' to convert what you've snipped into a saved .png file in your Pictures folder, which you then upload to photobucket.com or some other sharing site. Click on Windows 'Accessories" and Snipping Tool will display, click on it.

Once you have uploaded the saved .png file to photobucket, etc, you then embed the 'IMG' link for it in your post here and it will display. With my screen and resolution, I expand the preview of the Oximetry Report to 120%, snip half of it to fit, then snip the other half of it as a separate png.

Separate .png files uploaded to photobucket:



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