Severe REM-Related obstructive sleep apnea

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Severe REM-Related obstructive sleep apnea

Postby Perrybucsdad » Wed Aug 31, 2011 12:35 pm

Hi... I'm new to the forum, but this is exactly what I have been looking for.

A few years back my wife noted to me she thought I had sleep apnea and informed me that I snored like a freight train. I'm not a heavy person with a BMI of 24.2, so I really didn't think much of it.

I work for a hospital and recently came across an article on sleep apnea and decided to read it and noticed I had a number of symptoms (waking up not feeling refreshed, always tired, irritable, etc). I set up a meeting with a doctor here at the Cleveland Clinic and he examined me and saw that I had a deviated septum. Because I have an artificial heart valve and am on blood thinners, he said he wanted to try non-invasive methods first so he ordered a PSG (with no CPAP). I have posted the results below and am awaiting my apt with the doctor to review these and the next steps.

Just curious if anyone could give their interpretation to all this. I'm new to the Apnea stuff, so not a lot of it makes sense to me.

Thanks... John

=========
Results
=========

Age: 42 (DOB: 4/14/1969) ESS: 7/24 Neck Circumference
(cm): 40.0
Height (cm): 182.9 Weight (kg): 80.9 BMI: 24.2
Referring Provider: Alan Kominsky Mailcode: A71
Sleep history: The patient is a 42 year old male with snoring, witnessed
apneas, and excessive daytime sleepiness and fatigue.
Past medical history: Subclavian Aneurysm, Coarctation of Aorta, Valvular
heart disorder(mitral and aortic), Hypertension, Craniotomy for Aneurysm
Medications: Fluticasone Spray, Paxil, Coreg, Coumadin,
Lisinopril, Lipitor, Claritin, Ativan, Amiloride-Hydrochlorthiazide
Sleep procedure: PSG 4 or more addtl param PC (95810)
Procedure: The study was attended continuously by a sleep technologist. The
monitored parameters included: left and right EOG, frontal, central and
occipital EEG, mental and submental EMG, left and right anterior tibialis
EMG, single ECG waveform, snoring, continuous airflow with thermistor and
nasal pressure transducer, chest and abdominal effort, oxygen saturation,
EtCO2, and body position via video monitoring.
Hypopnea definition: The nasal pressure signal excursions (or those of the
alternative hypopnea sensor) drop by =50% of baseline. The duration of this
drop occurs for a period lasting at least 10 seconds. There is a =3%
desaturation from pre-event baseline or the event is associated with an
arousal. At least 90% of the event?s duration must meet the amplitude
reduction criteria for hypopnea.
SLEEP ARCHITECTURE:
The study started at 21:44:57 and ended at 06:03:57. Total sleep time was 423
minutes resulting in a sleep efficiency of 86.2% (TRT = 490 m). There were 23
awakenings with a total time awake after sleep onset of 40.0 minutes. The
sleep latency was 27.5 minutes and the REM latency was 301 minutes. The
patient spent 27.0% of sleep time in the supine position. The sleep stage
percentages were 8.5% stage N1, 49.2% stage N2, 21.2% stage N3 and 21.2% REM
sleep. There were 278 arousals, resulting in an arousal index of 39.4. There
were 160 stage shifts.
RESPIRATORY DATA:
Moderate snoring was noted. There were 164 respiratory events consisting of
54 apneas (31 obstructive, 8 mixed, and 15 central) and 110 hypopneas. The
apnea-hypopnea index was 23.3. The mean oxygen saturation during the study
was 96.0%, with a minimum oxygen saturation of 81.0%. The patient spent 0.9%
of sleep time with an oxygen saturation below 90%. The patient spent 20.2%
of sleep time with an EtCO2 above 45 mmHg and 2.2% above 50 mmHg.
REM-Time REM-Index NREM-Time NREM-Index Total-Time Total-Index
Supine 58.0 m 67.2 56.0 m 26.8 114.0 m 47.4
Off-Supine 31.5 m 38.1 277.5 m 11.7 309.0 m 14.4
Total 89.5 m 57.0 333.5 m 14.2 423.0 m 23.3
LIMB MOVEMENT DATA:
There were 30 periodic limb movements during sleep, resulting in a PLM-index
of 4.3. Of these, 18 movements were associated with arousals, resulting in a
PLM-arousal index of 2.6.
ECG DATA:
The average heart rate during sleep was 62 beats per minute, with a range of
46 to 78. During wake, the heart rate ranged from 50 to 73 beats per minute.
ICSD DIAGNOSIS:
Obstructive Sleep Apnea Syndrome [327.23]
IMPRESSION:
1. Severe REM-related obstructive sleep apnea syndrome (the total AHI was of
moderate degree). The respiratory events were associated with significant
oxygen desaturations (nadir of 81% on room air).
2. Abnormal sleep architecture likely due to respiratory events and first
night effect.
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Perrybucsdad
 
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Location: Perry, Ohio
Year Diagnosed: 2011

Re: Severe REM-Related obstructive sleep apnea

Postby Perrybucsdad » Thu Sep 01, 2011 1:27 pm

Anyone able to help me with this and translate it into english?
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Re: Severe REM-Related obstructive sleep apnea

Postby SleepyToo » Fri Sep 02, 2011 7:45 pm

Not a doc or a technician, but it appears to me that you may have complex apnea, which will require a more complex machine than a straight CPAP. Definitely questions for your doc should include what do the various things mean. While you are waiting for that visit with the doc, you might want to sleep on your side and see how that works for you. I don't see whether you had the same pattern of mixed apneas when you were on your side as on your back, but may be worth a try. You can try a tennis ball sewn into a t-shirt to make it too uncomfortable to sleep on your back ... Hopefully, someone with more knowledge of complex apnea will chime in and correct me and give you further guidance on what it all means. With the long weekend you may be lucky if you get many responses before next week ... although there are members from other countries who may be able to help.

Good luck with getting some answers.
SleepyToo
Philadelphia Area
Diagnosed September 2009, Respironics System One w/ C-flex and humidifier
Aloha nasal pillows
Not a medical professional, just a patient with severe OSA (31) who has done a lot of reading.
SleepyToo
 
Posts: 1066
Joined: Thu Sep 17, 2009 6:36 pm
Location: North of Philadelphia
Machine: PR System One
Mask: Resmed Swift FX
Humidifier: Yes, integral with PRS1
Year Diagnosed: 2009

Re: Severe REM-Related obstructive sleep apnea

Postby Perrybucsdad » Fri Sep 02, 2011 9:42 pm

Thanks..... I normally don't sleep on my back and always have been a side/stomach sleeper. It's hard to see as the numbers crunched themselves together, but the numbers are in all that data that shows where I spent most of my time, which was off supine. Basically it says I slept for 309 minutes in the off supine position with an index or 14.4 (what does that index mean) and supine time of 114 minutes and an index of 47.4.
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Posts: 47
Joined: Wed Aug 31, 2011 12:26 pm
Location: Perry, Ohio
Year Diagnosed: 2011

Re: Severe REM-Related obstructive sleep apnea

Postby SleepyToo » Fri Sep 02, 2011 10:00 pm

OK, these are easy questions to answer - the index is the number of times per hour that you stopped (or partly stopped) breathing each hour (averaged over the time you actually slept) in the off-supine positions. That is why they say that you have moderate sleep apnea for that time. During the supine time, which was less than 2 hours, you stopped breathing 47.4 times each full hour. Overall, you stopped breathing 23 times/hour. Fortunately, you only slightly desaturated ("normal" people stay above 90% all of the time - mostly above 96%, I believe). I have no idea what the CO2 levels actually mean, but the trigger for breathing is normally rising CO2 levels.

Hope this helps.
SleepyToo
Philadelphia Area
Diagnosed September 2009, Respironics System One w/ C-flex and humidifier
Aloha nasal pillows
Not a medical professional, just a patient with severe OSA (31) who has done a lot of reading.
SleepyToo
 
Posts: 1066
Joined: Thu Sep 17, 2009 6:36 pm
Location: North of Philadelphia
Machine: PR System One
Mask: Resmed Swift FX
Humidifier: Yes, integral with PRS1
Year Diagnosed: 2009

Re: Severe REM-Related obstructive sleep apnea

Postby Perrybucsdad » Fri Sep 02, 2011 10:32 pm

47.4 times each hour on my back and 23 times combined an hour... no wonder I am always so flippen tired. Can't wait to get some relief... I hope I get that device soon.
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Perrybucsdad
 
Posts: 47
Joined: Wed Aug 31, 2011 12:26 pm
Location: Perry, Ohio
Year Diagnosed: 2011

Re: Severe REM-Related obstructive sleep apnea

Postby SleepyToo » Sat Sep 03, 2011 8:40 am

Keep in mind that those numbers are just an average, and a snapshot of one night! Keep on at the docs to get you the device ASAP (the squeaky wheel gets the oil sooner!). Make sure that it has the ability to give you full efficacy data - AHI, leak rate at the very least. The more information you can get from your machine the better. Many providers will tell you that you don't need that level of information, but that is complete BS! You want to be able to manage your treatment in the same way that a diabetic manages their blood sugar. You cannot do that with a machine that only tells you how many hours you used it for last night. The insurance codes are the same for a machine with compliance-only data and one with full efficacy data; the only difference is that the DME makes a little less profit on the full efficacy data machine.
SleepyToo
Philadelphia Area
Diagnosed September 2009, Respironics System One w/ C-flex and humidifier
Aloha nasal pillows
Not a medical professional, just a patient with severe OSA (31) who has done a lot of reading.
SleepyToo
 
Posts: 1066
Joined: Thu Sep 17, 2009 6:36 pm
Location: North of Philadelphia
Machine: PR System One
Mask: Resmed Swift FX
Humidifier: Yes, integral with PRS1
Year Diagnosed: 2009



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