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Another polysomnogram and titration study

This area is for discussion of Sleep Studies used in the evaluation of Sleep Apnea.

Another polysomnogram and titration study

Postby Linda B » Tue Mar 21, 2006 11:27 pm

First a little background info: Back in early November I went to the hospital for day surgery on a bone spur in my foot. They wouldn't do it because my resting blood oxygen level was in the low 80's. Two days later my family doctor put me on 2 liters oxygen 24/7 and referred me to a pulmonologist. After spirometry and diffusion tests, she diagnosed me with COPD and prescribed Singulair and Advair. She also said to use the oxygen only at night at 3 liters and during the day when active. She also ordered the sleep study based on symptoms and my physical characteristics -- obese (275lbs), 5'4", 57 year old female with a small mouth, no tonsils, some snoring. Prior to using the oxygen, I was becoming uncontrollably sleepy during the day and short of breath at the slightest exertion. ( The sleepiness stopped almost immediately after starting the oxygen. I still get out of breath, but can now get from one end of the house to the other without heavy breathing. Stairs, however, are another matter entirely!!)

The only information I have from my sleep study done in early February is listed below. I don't have any of the graphs.

Recording time: 6 hours, 40 minutes
Sleep time: 3 hours, 48.5 minutes
Sleep latency: 23.5 minutes
REM latency: 3 hours, 43 minutes
Overal sleep efficiency: 57.13%

Stage awake: 42.9%
Stage I: 6.1%
Stage II: 42.8%
Stage III: 0.9%
Stage IV: 0%
Stage REM: 7.4%

Obstructive hypopneas: 22
Obstructive apneas: 19
AHI: 10.77
REM AHI: 61.02
All occurred in lateral position.
Oxygen saturation nadir was 80% during a 16 second apnea
Longest event was 32 second hypopnea with a minimum saturation 92%
(I should mention that I was on an oxygen flow of 2 liters during the whole night.)

7 awakenings
sleep onset 148 minutes
13 arousals associated with leg movements for an index of 3.4
60 spontaneous arousals for an index of 15.8

35 limb movements during PLMS for an index of 9.2 and 8 associated with microarousals for an index of 2.1

Mild obstructive sleep apnea, which is severe during REM sleep in a patient with physical findings consistent with obstructive sleep apnea and a reduced sleep efficiency with decreased amount of REM sleep. I (doctor) would have her come back in for a CPAP titration to see if we can alleviate her obstructive sleep apnea and hypoxemic respiratoroy failure in association. We will follow-up in the clinic after she has had her CPCP titration performed.

-- -- ------------

The titration study was done last Wednesday. I don't have any official results except what the technician told me. First of all, I had a hard time getting to sleep because: 1) wasn't sleepy at 11pm ( I normally go to bed about 2AM and sleep until mid-morning); 2) all the stuff cemented, glued, velcroed, etc. all over my body; 3) wearing pajama bottoms; 4) a twin bed when I'm used to more than my fair share of a king-sized bed; and 5) both my hips hurting from a sciatic nerve problem I've been having.

I was just about to doze off when the tech came in to start the oxygen. He said I was desating into the low 80's after 15 minutes of laying down. He started it at 1 liter. He came back two more times to raise the oxygen, finally getting it up to three where it should have been. Then I had to go to the bathroom. Then I started trying to sleep again and had the covers off, but was getting chilled. I laid there trying to sleep anyway, but finally had to raise up to reach them and pull them up. I thought I would never get back to sleep. Just about the time I think I was getting to sleep, the mask began to leak. I tightened the straps. It would be okay for a few minutes, then start to leak again. This seemed to go on for the rest of the night.

Finally the tech came in and said it was 6AM. I mentioned how frustrated I was with the leaking. He said, "Yeah, that was happening almost everytime I raised the air flow." He said he was just about to put me on BiPAP because the flow was up to 12 for the few minutes I was in REM when it woke me up again. By then it was time to get up anyway.

So I don't know it that was a total bust or what. And I certainly don't want to wait until my next appointment with the pulmonologist in May before finding out the results and starting the CPAP/BiPAP if it is called for.

How soon after a titration can one expect the results to be determined and will the doctor ever give that info out over the phone?

Sorry this is so long, but I could tell from other posts that you need as much information as possible to make educated comments, which I would very much appreciate.
Linda B. in Tennessee
There is power in positive thinking.
Linda B
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Joined: Mon Feb 06, 2006 2:08 pm
Location: Knoxville, TN, USA

Postby CrohnieToo » Wed Mar 22, 2006 12:30 am

Linda, I am new at all of this myself. And what transpires in my area and w/my doctor isn't necessarily the way it is going to happen w/you and your doctor. That being said: I had my first sleep study on a Monday, they called me Wednesday to schedule me for the CPAP study the following Monday. I picked up the report on Thursday. As it turned out I was unable to do the CPAP study and haven't done it yet so I can't tell you how soon after the CPAP sleep I would have had the equipment set up in my home but I'm guessing it would have been w/in two weeks at the most. Hopefully, others who have gone thru the whole process already will post replies shortly to give you a better idea of what to expect.
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Some Night

Postby sleepydave » Wed Mar 22, 2006 7:40 am

Hi LB:
Well, this doesn't look the the worst 2 nights I've ever seen.

No, on second thought, it is.

Might be tough to salvage info outta all this. Having that other data, including graphs, will be helpful. As well as any other medications or medical conditions that might be pertinent.

Can't judge too much till we get the results of the titration. It may be OK.

In the diagnostic, looks like only about 17 minutes of REM, so 17, 18 of your events were in there. I'll bet every one of the REM events was an apnea. If my adds and subtracts don't fail me, that makes your NREM AHI only about 7, that could be helpful. With that big a disparity, maybe an AutoBiPAP would be the way to go. Especially if there's a chance that the REM was not appropriately analyzed in the titration.

However, if you need supplemental oxygen, the variability of the changing pressures might also mess up the concentration of the oxygen (since the flow rate would be fixed) so you gotta set that up carefully and/or closely monitor that.

If your CO2 is elevated, however, then a fixed BiPAP pressure(s) might be fine.
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