Sleep architecture:
Recording period: 388.5 Minutes
Sleep Latency is 6.5
REM Latency is 116.5
Sleep efficiency is 94%
Distribution of sleep stages:
Stage 1: 23%
Stage 2: 46%
Slow wave: 9%
REM: 22%
Review of patient's histogram shows a few brief arrousals early on in the night with several captured periods of REM three total. The first in Supine position, the second in the lateral position that is quite prolonged. The third is split between supine and lateral sleep. The worse desaturations occur during REM supine sleep dropping all the way down into the mid to high 60% range. Obstructive events are very frequent throughout the night.
Respiratory Monitoring:
Baseline respiratory rate is 14 with an O2 saturation of 94 to 96% while awake. A total of 516 respiratory events are seen, giving an RDI of 84.9. A total of 211 apneas and 305 hypopneas are seen.
Supine position: 165 minutes of sleep recorded with an RDI of 108.0. Minimum O2 saturations down to 67%.
Lateral sleep: 199.5 minutes recorded with an RDI of 65.9, and minimum O2 saturations down to 72%.
REM sleep is seen in both the lateral and supine position with an RDI of 78.1 and 92.6 respectively.
Minimum O2 saturations down to 67%. Review of the physical recording shows events typical of obstructive sleep apnea with associated arousals and these saturations occurring nearly continuously throughout the night. The patient did not meet criteria for split night study due to poor sleep at the beginning of the study.
EKG:
EKG shows a regular rythm. Significant dysrhythmias are not seen.
EMG:
Occasional movements are seen. PLMS index - 0.
EEG:
EEG shows a normal waking background. NREM, SWS, and REM sleep are recorded with normal patterns.
Interpretation: Abnormal polysomnogram showing;
1. Sever obstructive sleep apnea with an overall RDI of 84.9, lateral RDI of 65.9, climbing to 78.1 during lateral REM sleep, supine RDI of 108.0 with REM supine RDI of 92.6. Minimum O2 saturations drop down to 67%. The patient did not meet criteria for a split night study.
2. The patient describes drinking alcohol specifically beer on weekends. IF that is done within a few hours of bedtime that could worsen his obstructive sleep apnea.
3. Evidence of poor sleep hygiene on sleep questionnaire given his description of smoking prior to bedtime or when he awakens during the night. He also notes kicking or jerking of his limbs and restless sleep but was not witnessed during this study.
Recommendations:
1. Weight reduction if clinically appropriate.
2. Avoid respiratory depressants.
3. TSH if clinically appropriate.
4. Recommend a CPAP titration polysomnogram.
5. Consider surgical intervention if he is not tolerant of CPAP.
6. The patient needs to improve his sleep hygiene smoking just before bed or in the middle of the night is inappropriate given that nicotine is a stimulant.
So...is this pretty bad, about normal or what. What is TSH??? It all sounds bad to me.
