Help needed to interpret sleep study results

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Help needed to interpret sleep study results

Postby sydknits » Mon Jul 31, 2006 3:28 pm

I got a copy of my 2 sleep studies today. I won't bore you with the 1st study results. I slept on my side most of the night (no one bothered to mention that I should try to sleep on my back), so no OSA to speak of showed up. Thankfully I was able to see my "official" sleep doc for my follow-up visit (I only saw the first doctor because she had a cancellation and could get me in sooner. I should have waited the extra week or two to get it right the first time, but oh well...). Anyway, the 2nd doc looked at the first sleep study results, but looked more closely at my history (fibromyalgia, chronic fatigue, headaches, depression that wasn't responding to meds, recent weight gain, etc) and insisted on a 2nd study because she was certain that I had SA, and she was right!

Here are the results from my split study. I left out the info that didn't seem critical - I hope I got it right. I have a few questions of my own, but in general, would appreciate any thoughts on these results as they are all like Greek to me. After having been misdiagnosed for at least the past 15 years, I'm determined to take a proactive role in my treatment from here on.

FYI - I am a 47-yr-old female, 5'1", 138 lbs.



Sleep Architecture:
Sleep Efficiency 68.9%
Sleep Onset Latency 42.6 min
Number of Stage 1 shifts 17
Number of Stage shifts 43
Number of Awakenings 15
Number of REM periods 1
REM Latency 163.0 min
REM Latency minus Awake 137.0 min

Sleep Stages:
Stage 1 29.6%
Stage 2 64.0%
Stage 3 0.0%
Stage 4 0.0%
Stage REM 6.4%

PLMs and Sleep Stages:
PLM-Arousal Index All-PLM Index PLM-Arousal Total All-PLM Total
Total Sleep 0.7 1.8 2 5
Stage REM 0.0 0.0 0 0

Spontaneous Arousals:
Index Total
Total Events 1.5 4
NREM 1.6 4
REM 0.0 0

Respiratory Events:
Central Obstructive Mixed Apneas Hypopneas
Number 33 11 0 44 97
Index 12.1 4.0 0.0 16.1 35.5
Mean Duration 10.1 10.1 n/a 10.2 14.7
Longest Duration 13.1 13.0 n/a 13.1 25.8

Respiratory Events w/Arousals:
Index Total
Total Events 51.6 141
NREM 51.2 131
REM 57.1 10

Oxygen Saturation:
Awake NREM REM
Mean SaO2% 96.8 96.3 97.2
Min SaO2 93.0 93.5 95.0
Max SaO2 100.5 99.0 99.0

Pressure Level Analysis:
Pressure OSA CSA Mixed Hypopneas Total Events RDI
0 11 33 0 97 141 51.6
5 0 0 0 6 6 11.3
7 0 0 0 1 1 0.8
8 0 0 0 0 0 0.0
9 0 0 0 1 1 6.0
11 0 0 0 5 7 3.8


Are you still with me? LOL

Here are my initial questions:

* I noticed no Stage 3 or 4 sleep and very little REM. I know that non-REM is a problem, but what about Stage 3 and 4?
* In talking to my dr (we discussed the results by phone), I was expecting OSA, but CSA was a shock - 3 times more than OSA. Is this significant? Are they treated the same with respect to CPAP?
* I was surprised to see that my oxygen levels didn't go down despite the high(?) number of apneas and hypopneas. I thought I saw in the Glossary here (great, BTW) that severe SA was determined by a combination of the AHI and a significantly reduced oxygen saturation. I'm assuming it's a good thing that it didn't dip, but I don't understand why it didn't.
* On the pressure level analysis, I noticed that there were no events at 8cmH20, but my dr prescribed a pressure of 12. According to the chart, there were more events at 9 and 11 than at 8. Why would they go higher than 8 then? The only thing I can think of is a slightly higher mean SAO2 (99.5% at 11 vs. 97.1% at 8). Any thoughts?

Thanks so much!

One more sleepless night... (Hopefully - I get my CPAP tomorrow)

Oh no... I just looked at the preview and realized that none of my tabs took. Darn it! I spent a lot of time making nice little columns so this would be easy to read. Sorry!
Syd
Diagnosed w/severe OSA on 7/27/06
Started APAP on 8/01/06
Respironics REMstar Auto with C-Flex.
w/humidifier
Hybrid mask 9/06 to 9/07
Started Opus mask on 9/21/07
Pressure at 5-16
sydknits
 
Posts: 23
Joined: Fri Jul 28, 2006 2:45 pm

The More Things Change

Postby sleepydave » Mon Jul 31, 2006 9:54 pm

Hi sydknits:
While it's a little tough to draw conclusions without the rest of the data (particularly the graphs) let me just throw this out, because I know you're short on time.

You're right about the O2 sats. There's barely any room to have any desats, period. And an overall laundry list of things that can destroy sleep architecture. And a split that must've been short on time. And if you only had one REM period, it looks like it was in the diagnostic, so we don't know how you did in REM during the titration.

While you can't really equate amount of pressure with severity of OSA, 12 cmH2O seems like a ton. And as you also note, there's plenty of time where lower pressures are fine.

This means that you should be an excellent candidate for an Auto-Titrating unit. Because of what we see, and of what we don't see. With that much sleep fragmentation, you really don't want any more pressure than is necessary, and sometimes just hitting the ramp button won't do it.

See if you can at least get a trial with APAP, I think sitting on a hard 12 will be tough.

If you want to read some more, check out the stories of Miss Rumphius and ponder276 here in the studies section.
sleepydave
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Re: Help needed to interpret sleep study results

Postby rested gal » Mon Jul 31, 2006 10:35 pm

sydknits wrote:After having been misdiagnosed for at least the past 15 years, I'm determined to take a proactive role in my treatment from here on.


Good for you, syd!!

For the reasons that sleepydave gave, an autopap (auto-titrating cpap, APAP, all the same thing) is what you should really, really, REALLY, push for rather than a straight cpap machine. Lower pressures than 12 may very well do the job just fine for you throughout most of the night, most nights. An APAP will vary the pressure as needed instead of blasting you with a straight 12 all night long.

I'm not a doctor or anything in the health care field. Just a very happy, very well-treated autopap user....very proactive in my own treatment. :-)
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Postby sydknits » Mon Jul 31, 2006 10:46 pm

Sleepydave and Rested Gal,

Thanks so much for your prompt replies. I'm optimistically hoping that this will be my last totally useless night (lack of sleepwise), so I'm up reorganizing my home office. Once I'm feeling better I'm looking forward to the burst of energy I'm going to have so I want to be organized and ready to roll! LOL

I do have some graphs but don't have a clue about how to post them here. If there's a link to some instructions from a previous post please let me know and I'll add them.

In reply to some of your other comments...

* What is the significance of desats? I know what it means (I think), but I'm not sure what you mean when you say that there's "barely any room here." Please explain.
* Yes, the split study was cut about 2 hrs short because I couldn't fall asleep, despite being exhausted. I ended up getting an Ambien, but even with that it took almost 30 more minutes. At one time, I was taking 2 Ambien, Klonazipam (sp?) and Seroquel, all that the same time, and still not sleeping. You'd think that would have been a clue that something was wrong. It wasn't until I insisted that I would not add another pill or increase the dosage again that I finally got a sleep study!
* Actually the REM sleep was during titration. It was virtually non-existent during the first half of the night.

I'll bring up the autopap question when I see the DME folks in the morning. I'm wondering if there's any chance of getting that now since my doc already prescribed a CPAP. Is it a lot more expensive? I found out today that my existing insurance (that I'm about to lose anyway), covers only 50% of DME. I'll have to pay for 50% of the mask, tubing, and headstraps (?) tomorrow and 1/2 of the monthly rental for the machine for a few months. Since I don't expect to be with them much longer, I'm going to end up paying for the bulk of the machine out-of-pocket so while I want wants going to be best for me in the long run, I also am cost-conscious too.

That raises another question... Do the CPAP machines measure AHI or any other indicators of how successful they are at treating the problem, or must we rely solely on how we feel? How will I know if 12 is too much for me or if I can have comparable success at a lower pressure? Will I be able to change the pressure settings myself?

Thanks!
Syd
Diagnosed w/severe OSA on 7/27/06
Started APAP on 8/01/06
Respironics REMstar Auto with C-Flex.
w/humidifier
Hybrid mask 9/06 to 9/07
Started Opus mask on 9/21/07
Pressure at 5-16
sydknits
 
Posts: 23
Joined: Fri Jul 28, 2006 2:45 pm



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