Deciphering Somnologica report

[turbosnore]

Can anyone explain me how to read the sleep study report generated by Somnologica?

Does hypoventilation show in the report? If it does, in what way?

I recall seeing somewhere that the flattening means flattening of a curve.
Which curve?

What is the "threshold" in the flattening section? It says in the report:
"Breaths below threshold 3362 58.8%".

What is "PLM"?

How to read the SpO2 statistics table?

How to read the desaturation statistics?
(average OD/h [%] and average OD/h fall [%])

I tried to copy the statistics tables here,but the formatting become unreadable.
I'll link the report a bit later. I have to scan it, because all I have is a
paper print.
[edit]

Here's the report
report.doc

[turbosnore]

Link to the report is now available.

[echo]

That's a boatload of info there. Not too difficult though if you go through it step by step...

Can anyone explain me how to read the sleep study report generated by Somnologica?

Does hypoventilation show in the report? If it does, in what way?
I don't know anything about that (and remember I'm no doc).

I recall seeing somewhere that the flattening means flattening of a curve.
Which curve?
Probably your breathing waveform (curve).

What is the "threshold" in the flattening section? It says in the report:
"Breaths below threshold 3362 58.8%".
I'm assuming that means that your inspiration waveform was reduced. This means that you're not inhaling a full breath (therefore the breathing is obstructed). And I would think that 58.8% of the time, your breathing was obstructed in some way. Take a look at these graphs: flow events
You see how the apnea's and the other events have a lower peak in the middle section of the graph? That's the reduced waveform. The 'threshold' is probably some level above which breathing is considered normal, and if the waveform is reduced beyond that threshold, it's marked as an obstruction (apnea, hypopnea).

What is "PLM"?
Periodic Limb Movements. It means that you're moving your arms and your legs, and it's causing arousals. In your case mopst of them were spontaneous and not connected to the breathing disorder. (top of page 4). LM's can screw with your sleep architecture and cause daytime sleepiness even if the OSA is resolved.

How to read the SpO2 statistics table?
Anything below 90% is considered BAD. You didn't spend a lot of time below 90%, but on the other hand (in my opinion) anything less than your normal oxygen saturation (which is normally 98 or 99%) is not good. Supine=on your back. Non-supine=on your side or stomach. Not sure what the difference between the non-cumulative and cumulative columns are, but I'd go with the latter. Average desaturation of 5.9% just means that on average you had 6% less oxygen in your bloodstream than when awake. Your lowest desat was 81%, which is not good (and you spent 8 minutes there, pretty significant). All those are due to apnea's and hypopnea's (i.e. the breathing waveform flattening).

How to read the desaturation statistics?
(average OD/h [%] and average OD/h fall [%])
I'm guessing that's Oxygen Desaturation. Fall probably means how much your oxygen levels were reduced. It's just another way of representing the previous informaation, but then in terms of 'per hour'. So for example your highest "fall"(or decline) was in the range of 5-9%, at a rate of 20 per hour. So 20 times per hour, your oxygen saturation fell by 5 to 9% (but to know for how long you were desaturated you would have to use the previous table). Together with the other desaturations (total of 29.9 per hour), these are correlated with the AHI of 36 events per hour.

In summary = you are desaturating in your sleep, anywhere from 5% to 20% and that is BAD. You NEED CPAP. The CPAP may or may not help with the limb movements, so you may have to work with your sleep doc to find a solution to those. Any type of arousal will wreck your sleep architecture.

[turbosnore]

Thanks a million. I got a lot of enlightment.

Special thanks for giving me some sort of perspective on the seriousness of my figures, and also
reflecting them back to the curves for me. It has been bothering me a little not knowing
the level of severity of the figures.

Now I'm beginning to understand.

About the limbic movements, they have never bothered me in any way. I haven't even realised I had that
until my doctor told me about me having light symptoms of restless feet. I usually fall into sleep almost
at the same time my ear hits my pillow (sometimes a little earlier ).

[echo]

Glad that helped! It does take time to get used to all the terminology. (And i'm still guessing at some of the terminology on your report, so take it with a grain of salt. Check with your sleep doc to be 100% sure).

BTW I don't know much about PLM, but some have reported that it gets better after starting CPAP therapy. I have no idea if yours would improve, since they were not correlated with any obstructive events, but I guess you will find out soon enough. If you're on the right pressure, you've eliminated leaks, your AHI is low, and you're still not feeling well, then you should discuss the PLM with your doc further. Of course there can be other reasons for not feeling, including meds, other health conditions, GERD, etc.

I hope your turbosnoring has become less

[looking4zzzz]

Periodic Leg Movements can hurt your sleep without your realizing it. It can keep you from getting into the deeper, more restorative levels of sleep without fully waking you up. When I had my first sleep study, I was having 86 arousals per hour, which averages more than one per minute. I was not aware of any of the movements, but they were definitely contributing to my daytime tiredness. I wouldn't write them off just because you don't feel them. Check with your doc and see if treatment would be helpful.

[turbosnore]

I talked, and my doc said that there is no treatment for restless legs. Only the psychological part can be helped,
but since I'm not even aware of it, that wouln't help me. I guess that for me it's the oxygen level that needs
attention.

Anyway, thanks again!

[dwood003]

There is no cure for RLS but there is a treatment. I did not tell the Doctor I had RLS before my sleep study because I did'nt realized it happened in my sleep. He immediately gave me a card containing two weeks of tablets that increased the doseage gradually from 1/4 mg to 1mg. Requip is the manufacture.I then went from 1mg to 2mg now 4mg a day, I take the generic Ropinirole. I take it 3 times a day. I taped myself with a infrared camcorder at night and I still kick all night long. The side effects of the medication where very uncomfortable to start with but I'm not aware of any now.

[Snoredog]

DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOPNEA INDEX (AHI) = apnea plus (+) HYPOPNEA/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytime somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%
As established by AASM/ABSM 1999.

Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%

Stage3&4, REM decrease as we age.
============================================================

your total AHI was 36.0 /h (severe) made worse or increasing to 58/h in supine (on your back) putting you in the severe OSA range. O2 levels were dropping to 80% putting you in the moderate-severe range. PLM was seen but many didn't cause an associated arousal to sleep, a few did but not many.

3 Central Apnea and Mixed apnea (traits seen with CSDB) were seen during the study, might want to keep an eye on those with any treatment you go with. If that was seen during the diagnostic portion of the study the potential for them remaining with therapy and/or becoming worse could happen, on the other hand they may go away altogether. If you go with an autopap, you want one that AVOIDs any response to Centrals. Depending on your pressure requirement, I would suggest the Sandman Auto. It will do the best job at avoiding any response to those.

CPAP treatment should eliminate the OSA events, a Sandman Auto w/software would let you know how well it treats the SDB and what happens to the central events. You won't know if the Limb movements settle down without monitoring that in the lab.

[rested gal]

your total AHI was 36.0 /h (severe)

I agree that's severe.

3 Central Apnea and Mixed apnea (traits seen with CSDB) were seen during the study, might want to keep an eye on those with any treatment you go with. If that was seen during the diagnostic portion of the study the potential for them remaining with therapy and/or becoming worse could happen, on the other hand they may go away altogether. If you go with an autopap, you want one that AVOIDs any response to Centrals. Depending on your pressure requirement, I would suggest the Sandman Auto. It will do the best job at avoiding any response to those.

Puritan Bennett machines are good ones, and the Puritan Bennett/Covidien Sandman machine would be a nice machine to have. But 3 centrals and a few mixed apneas showing up on a diagnostic PSG are hardly a reason to think a person needs to have a machine that can identify some centrals. I don't think there's any reason whatsoever to be concerned about the fact that a small number of centrals showed up in the study. I don't think their presence on the diagnostic study is any reason at all to seek out a particular brand of machine. Any brand would probably treat turbosnore's OSA equally as well as any other. Just my opinion.

turbosnore, as dwood mentioned, there ARE meds -- same ones are used for PLMD as for RLS...usually Requip or Mirapex. However, as Snoredog correctly pointed out...unless the PLMD (Periodic Limb Movement Disorder) actually caused enough arousals to wreck sleep architecture and cause me to still feel sleepy in the daytime despite cpap treatment taking care of sleep apnea fine, I personally would not start taking meds for PLMD (Periodic Limb Movement Disorder.)

Also, as Snoredog correctly said, the only way to see the number of arousals caused by PLMs is on the PSG (polysomnogram) sleep study data. And the only way to know if a person has true PLMD (Periodic Limb Movement Disorder) is if the PLMs persist during optimized cpap treatment -- as in a titration (a sleep tech applying cpap and adjusting the pressure in the sleep lab) during a PSG sleep study.

"Arousals", by the way, are not full wakeups. Arousals could be described kind'a like micro-wakeups..not necessarily hitting "Wake" at all. Arousals shift you from one sleep stage (or from REM) into a lighter stage of sleep...fragmenting the sleep architecture. Frequent arousals can leave a person tired, unrefreshed, and sleepy the next day.

Arousals can be from many things, including apneas and hypopneas, PLMs (Periodic Limb Movements), and RERAs. RERAs are Respiratory Effort Related Arousals -- from struggling to breathe better before an event becomes bad enough to score as a hypopnea or apnea.

Pain can cause arousals. A noise could, too. The list is endless.

[Snoredog]

3 Central Apnea and Mixed apnea (traits seen with CSDB) were seen during the study, might want to keep an eye on those with any treatment you go with. If that was seen during the diagnostic portion of the study the potential for them remaining with therapy and/or becoming worse could happen, on the other hand they may go away altogether.

Puritan Bennett machines are good ones, and the Puritan Bennett/Covidien Sandman machine would be a nice machine to have. But 3 centrals and a few mixed apneas showing up on a diagnostic PSG are hardly a reason to think a person needs to have a machine that can identify some centrals. I don't think there's any reason whatsoever to be concerned about the fact that a small number of centrals showed up in the study. I don't think their presence on the diagnostic study is any reason at all to seek out a particular brand of machine. Any brand would probably treat turbosnore's OSA equally as well as any other. Just my opinion.

Think I covered both ends of that argument in that one sentence. But no other machine is going to report the status of those CA's and Mixed events without a PSG. So with any other machine you will be totally blind to them and wanting to respond to them as if they were obstructive. You certainly cannot rely on that lousy Remstar NRAH circuit to avoid them. Gee I think it might be better to send them back for 3 or 4 PSG's to figure it out or why they are dead assed tired during the day

Fact is you won't know exactly what happens to this persons sleep until they go on therapy, the better feedback you get from the machine about that therapy the better. A night in the lab never tells the whole story.

And we know the damn doctors are only going to address the obstructive apnea portion of the disorder seen on the PSG, if the patient doesn't ask about those other items shown to interrupt their sleep they will be right back here wondering why they are still tired during the day after their AHI is below 5. Seen this play out here many many times.

If those other events are as insignificant as you suggest, then why in the hell do they even bother to report them? Why not include 3 ducks and 2 geese flew over the Sleep Clinic while the patient was snoring? What's the difference?

They are there and listed because the are shown to interrupt one's sleep.

[turbosnore]

Thanks, Snoredog!
I really got something to chew for a while.
Who the h... are you? Where have you got all the knowledge?

I'm an engineer (SW) and i'm getting very interested in what pressure and flow curves can reveal.
I've always been interested in science and engineering, even as a clild. Oh, I hope I have grown
since I'm 45 years old.

By the way, does anybody know if the O2 desaturation could be measured from the exhaled air?
Any ideas what should the CO2 or O2 consentration in the exhaled air be if the
O2 saturation of the blood is normal?

I'm starting to think of an idea of putting some sensors inside the mask...

[mindy]

You can also get a recording pulse oximeter that works quite well. I found that even though I have mild apnea (AHI in sleep lab was in the mild range), my O2 desats are definitely not great. Without cpap I go down to about 75% and spend 90% of the night below 94.

I have the Sandman Auto and it's much more fun to play with than the Respironics M-series Auto. There's a neat "waveform" report that shows obstructive apneas, central apneas, hypopneas, central hypopneas, snores and "runs" (flow limitations) as continuous "tracings", one on top of the other so you can see what occurred in the same timeframe, plus it has the other stuff too. I've been using mine for just almost a week and have been able to tweak my treatment much better in a week than I could with the M-series auto in a year. Probably just me - apparently the pressure may have been "chasing" the centrals whereas in the Sandman you can set a limit to the chasing.

Mindy

[ozij]

The important amount of oxygen to look at is the amount in your blood - that's where your brain and other parts of your body get their necessary oxygen.

You lungs have to extract enough oxygen and your blood has to have to capacity to pump enough oxygenated blood to the very ends of you body - so they measure the oxygenation in your finger tips. If you want to track your oxygen saturation, there are pulse oxymeters that will do it .

But 3 centrals and a few mixed apneas showing up on a diagnostic PSG are hardly a reason to think a person needs to have a machine that can identify some centrals. I don't think there's any reason whatsoever to be concerned about the fact that a small number of centrals showed up in the study.

If those other events are as insignificant as you suggest, then why in the hell do they even bother to report them? Why not include 3 ducks and 2 geese flew over the Sleep Clinic while the patient was snoring? What's the difference?

The difference, as you well know, is that they wouldn't bother to report 30 ducks and 20 geese either. They bother to report the number of central apneas because central apnea may effect sleep, but a small number of them is no reason for concern.

Reporting insignifcant numbers of significant variable is part of practicing good medicine and good science. As is the commitment to making a distiction between large and small numbers.

O.

[turbosnore]

Mindy, you seem to be right in that pulse oximeter is much better idea than analysing
exhaled gases. It measures the oxygenation of blood more directly, and it is much simpler:
just couple of LEDs and photo diodes of certain wavelengths and a microcontroller to handle them.
That would be around 30$ I guess. Even less if the microcontroller board is self-made.

I guess measuring during the night is best done from the ear lobe, so the wires could run
beside the hose - no more restrictions to movements than caused by the hose.

Light and small enough pressure sensor may cost about 20$. I don't know if they are fast enough
for detecting snore. [edit] Yes they are, mechanical response times are milliseconds.[\edit]

The measuring air flow is a bit more complicated matter.

The point here is that one could add all kinds of measurements of interest.
Of course the results may not be very reliable, but a project like this might
be interesting.