I thought I'd run this by you....

He had 5 obstructive apneas and 1 hypopnea (no central or mixed).  It looks to me like 5 occurred during REM.  And he had very little of REM, and no stage 1,3,4.  What is the significance of that?  Also, how is a "multiple sleep latency test" done?  (The doctor/nurse didn't mention any of the recommendations over the phone w/me.)


Impression:
No significant obstructive sleep apnea
Sleep onset delay
Significant degree of arousal
history of cerebral palsy

Recommendations:
1. multiple sleep latency test is suggested to further evaluate objectively patient's daytime sleepiness.
2. other causes for daytime sleepiness and distrubed sleep wake schedule, in particular circadian rhythm sleep disorder, mood disorder, and medication effects should be considered especially w/history of cerebral palsey.

Sleep Parameters Report:

BMI: 21.7
Lights out at 9:34 p.m.  (I don't think this is correct)
Tot. Recording Time (minutes)    446.8
Tot. Sleep Time                         306.0
Sleep Latency                            114.9
Time Awake After Sleep Onset       26.0
Sleep Efficiency                           58.5%
REM Latency                               87.5
Stage 1                                        0  %
Stage 2                                      93. %
Stage 3                                       0  %
Stage 4                                       0  %
Stage REM                                  7.0 %
Periodic Limb Movements   (the written summary states:  per. limb move. index=1.0)
Arousal Index                              0.6
Total Arousal Index                     11.2
Average Heart Rate                      57.9bmp
Study ended at 5:01 a.m.

Obstructions                                1.0 / hr
Hypopneas                                  0.2
Mixed Apneas                              0
Central Apneas                            0
Apnea/Hypopnea Index                 1.2
Respitory Disturbance Index-RDI
Supine AHI                                 0
Non-Supine AHI                          1.2
REM AHI                                    5.6
Non-REM AHI                             0.8
Average SaO2                           95.1%
Time SaO2 less than 90%   less than 1 min
Lowest SaO2                             89.0%

Cardiac Abnormalities Noted:  None


This is all the info I got....no specifics re: heart rate (only average) and nothing mentioned re: seizures.

FYI:   physiclogic parameters:  EEG 4 channels, EOG 2 channels, air flow at the nose and mouth, chin EMG, tibialis EMG, chest and abdominal movements, EKG w/surface electrodes, pulse oximetry, and body position.  

If you have anything additional to say about these results I'd appreciate hearing it.  I'm so surprised about the central apnea....well not surprised because I know I didn't witness any that night, but I'm sure I do some nights at home.  I have never felt that it occurs every night, but rather sporadically.  Is it possible that central apnea would occur sporadically (his internist doesn't think so....has said if it happens it happens every night).

I sure hope somebody replies!  i haven't heard from doctors either.


Why are the numbers for AHI (1.2) different than the numbers for REM AHI (0.8)+ Non-REM AHI (5.6)=6.4 ????  He slept for 5.1 hrs, so that's 6.3 per night.  You think those are the REM/NonREM numbers?  they're per night, not per hour?

1)Why would stage 3 & 4 sleep be non-existant if there is "insignificant" apnea?

2)what's the difference between "periodic limb movements/hour (1.0 per hour) and periodic limb movements Arousal Index? (0.6)  why are the numbers different?  .ooooooooooohhh, does that mean that during .4 periodic limb movements he was NOT aroused?  

3)and then the "tot. arousal index" is different again at 11.2.....  Does that mean there were 10.4 arousals unrelated to periodic limb movements?  (the "respiratory distrubance index-RDI" was left blank).  The text of the report states "total arousal index was less than 11.2 events per hour.  So that sounds like it's not significant.  But, in the section called "Impression"  it lists "significant degree of arousal".    Is it or is it not?... When people post here about having arousals above 40 and even 100 are those arousals really per hour, or are they for the entire sleep time???  If 11 is "significant"  what's 140?!?!?!

4)It also mentions an "ave O2 saturation of 95.1% with significant desaturation".  However, it then states " that the lowest SaO2 was 89.0% for less than 1 min."  That doesn't sound very significant to me....  Do you think that was a typo and is suppossed to say "insignificant"?
(When  2 overnight oxometries were done, a few months before the sleep study,  they each showed a couple desats, 1 being 88 and 1 being 77 but because the total time was less than 1 minute the pulmonologist and the DME both said it was not significant.  DME said that for insurance to pay for supplemental O2 it has to drop to 88 for at least 5 minutes).


can anybody help me with this?
Do I need to be concerned about the sleep stages, or ignore them since the apnea was "insignificant".

oh, 5) should the fact that the apnea-(5.6 episodes) occured during REM and there was only 30 min of REM make a difference?  I mean, should the real index be higher since it was 5.6 in 30 minutes as oppossed to 5 hrs?  (I guess even then it would only be an AHI of 5.6 + .8 of nonREM = 6.4 AHI which is still considered "insignificant" , right?)

............Then why''s he soooooooo tired????   coz of the the stage business?


thanks  

I am not an expert on this but let me offer some thoughts regarding some of your questions and then regarding your first post:

Quote:

1)Why would stage 3 & 4 sleep be non-existant if there is "insignificant" apnea?

I believe that the apnea was termed insignificant on account of the low AHI. This does not necessarily mean that the absence of stage 3/4 sleep is insignificant, but then there may be some reason other than apnea that is affecting stage 3/4 sleep.

Quote:

what's the difference between "periodic limb movements/hour (1.0 per hour) and periodic limb movements Arousal Index? (0.6) why are the numbers different? .ooooooooooohhh, does that mean that during .4 periodic limb movements he was NOT aroused?

I think you have figured this out.

Quote:

3)and then the "tot. arousal index" is different again at 11.2..... Does that mean there were 10.4 arousals unrelated to periodic limb movements? (the "respiratory distrubance index-RDI" was left blank). The text of the report states "total arousal index was less than 11.2 events per hour. So that sounds like it's not significant. But, in the section called "Impression" it lists "significant degree of arousal". Is it or is it not?... When people post here about having arousals above 40 and even 100 are those arousals really per hour, or are they for the entire sleep time??? If 11 is "significant" what's 140?!?!?!

Arousals are sometimes described in terms of an arousal index (# of arousals per houor of sleep) and sometimes in terms of the total numbers. I think that the doctor's terminology indicates that the amount of arousals is worth noting but I suspect that he he would have used stronger terminology if the arousal index was a lot higher. If the text says that the total arousal index was less than 11.2, I would interpret this (within the context of the report) as saying that the index was maybe 11.17 or 11.19.

Quote:

It also mentions an "ave O2 saturation of 95.1% with significant desaturation". However, it then states " that the lowest SaO2 was 89.0% for less than 1 min." That doesn't sound very significant to me.... Do you think that was a typo and is suppossed to say "insignificant"?

The term "significant" may have different meanings in different contexts. It seems to me that desaturation may be significant if it represents a 3% drop in oxygen level, or it may be significant if the O2 level falls to 89%, or it may be significant if it leads to arousal, or desaturations may be significant due to eiter their frequency or duration.

Quote:

should the fact that the apnea-(5.6 episodes) occured during REM and there was only 30 min of REM make a difference? I mean, should the real index be higher since it was 5.6 in 30 minutes as oppossed to 5 hrs?

I think it would make a little difference but not a lot. Ideally REM sleep is supposed to be 20 to 25% of total sleep time, your son had 7% REM. Still, if he were getting 25% REM sleep, this data suggests that if his overall AHI would still only be 2.0. (Please note that the results indicate that his REM AHI was 5.6, not that he had 5.6 episodes during REM sleep).

Quote:

Do I need to be concerned about the sleep stages, or ignore them since the apnea was "insignificant".

Yes, I think you definitely do. Your son's study may not show significant apnea but it does appear to represent a serious sleep disturbance, it just does not give a clear indication of what is causing this. There are a few different possibilities that your doctor mentions. I believe that the MSLT usually starts out with a full-night sleep study (which might help confirm the findings of this first sleep study, sometimes people can have very different sleep study results at different times), and then continues through the day with naps being offered at intervals throughout the day. This might provide some additional information with respect to daytime sleepiness and maybe circadian rhythm disturbance especially.

In reviewing these results with your son's doctor, I would especially want to ask more about the arousals (as these are the measurable factors most likely to affect stage 3/4 and REM sleep. Aroouslas are classified as being related to periodic limb movements, being related to breathing events (apnea, hypopneas and other respiratory-related events), snoring related arousals and spontaneous arousals (arousals whose cause is not clearly identified).

You may already be aware of this but this report looks like it is the summary of the sleep study. Further details would be available through the full study report (which, for example, would definitely talk about types of arousals and whether they were associated with REM, among other things). You might want to ask for a copy of the full report and not just the summary.

If your son has a neurologist you might want to ask about whether there are any types of sleep problems that might be associated with cerbral palsy. I did google sleep and cerebral palsy and fond a few isolated hints that people with cerebral palsy might have certain types of sleep problems (one study specifically mentionned delayed sleep onset, which your son's study definitely seems to show). Your son's sleep doctor (even if not a neurologist) might also be a resource regarding this question.

I hope this is of some help to you. I would be glad to read what others might say.
Do keep us posted.

Best wishes to you and your son,
Bill