Sleep study Interpretation: the good, bad, and ugly

Hello everyone. I was just diagnosed with sleep apnea. Here is my report from the sleep center:

INTERPRETATION

Total recording time was 416 minutes; total sleep time was 311 minutes (sleep efficiency 88%). The sleep onset latency was 60.5 minutes. The REM onset latency was 340.0 minutes. There were 100 sleep stage shifts and the arousal index was 46.4/hour.

Sleep Architecture:

Stage Wake: 12.3%
Stage REM: 3.0%
Stage N1: 9.9%
Stage N2: 74.9%
Stage N3: 0.0%

0 central, 5 obstructive, 0 mixed, and 196 partial apneas (hypopneas) combined for an apnea/hypopnea index of 38.7/hour of total sleep. The longest apneic event was a 58 second obstructive hypopnea. The mean SaO2 was 93%. The awake/baseline SaO2 was 94%, and the lowest SaO2 was 85%. Patient slept on two pillows and had one bathroom visit. He reported average sleep.

Variation in apnea by position or stage of sleep:

Left side : 0/hour Time spent in that position 00 minutes
Supine : 39/hour Time spent in that position 311 minutes
Right side: 0/hour Time spent in that position 00 minutes
REM Stage: 57/hour Time spent sleeping in REM stage 10 minutes

Continuous ECG revealed an average sleeping heart rate of 63 bpm with sinus rhythm.

Continuous left and right anterior tibialis muscle EMG revealed periodic limb movement (PLMS) with arousal at an index of 0.0/hour and PLMS without arousal at an index of 0.0/hour.

Impressions

1. Obstructive sleep apnea, severe, with REM component
2. AHI 38.7/hour, Supine AHI 38.7/hour, REM AHI 57.1/hour with minimum oxygen saturation of 85%.
3. PLMS of uncertain clinical significance.
4. Sleep fragmentation secondary to above.
5. Abnormal sleep architecture with delayed sleep onset latency, delayed REM onset latency, increased stage N2 sleep,
reduced stage REM sleep, and absent stage N3 sleep.

Addendum: I've had my second sleep study done. The sleep tech believes the sleep doctor will recommend either CPAP at 12 cm or Bilevel CPAP at 14 over 12.

What does every think? This is all new to me: Is this dangerous sleep apnea? Should I be majorly concerned? Are my recommended CPAP settings low, medium, or higher than the norm?

Thank you very much!!

Thewino

Thewino wrote:
Variation in apnea by position or stage of sleep:
Left side : 0/hour Time spent in that position 00 minutes
Supine : 39/hour Time spent in that position 311 minutes
Right side: 0/hour Time spent in that position 00 minutes
REM Stage: 57/hour Time spent sleeping in REM stage 10 minutes

Continuous left and right anterior tibialis muscle EMG revealed periodic limb movement (PLMS) with arousal at an index of 0.0/hour and PLMS without arousal at an index of 0.0/hour.

Impressions
2. AHI 38.7/hour, Supine AHI 38.7/hour, REM AHI 57.1/hour with minimum oxygen saturation of 85%.
3. PLMS of uncertain clinical significance.
4. Sleep fragmentation secondary to above.
Addendum: I've had my second sleep study done. The sleep tech believes the sleep doctor will recommend either CPAP at 12 cm or Bilevel CPAP at 14 over 12.

Hello and welcome. Just a few notes on the excerpts above...
... The PLMS notes seem contradictory. Can you clarify if there were or were not limb movements to be considered?
... The lack of any side sleeping prevents you from knowing if or how much of a positional component your sleep apnea might have. Don't know if supine is your position of choice or if it was as instructed for the study. Sometimes those who have difficulties with higher pressures can, if their events are positional, mitigate the need for higher pressure. Not an issue now, but something to keep in mind.

Since you've had your 2nd study, maybe some of those questions were answered/resolved in that report. Do you have it yet? Hopefully both your sleep stages and oxygen levels will normalize with effective treatment.

No, Miss Teague, I have not received the report from my second sleep study. It should arrive in about a week.

The posted report is correct. I do not have any "periodic limb movements" as I also have serious pain issues. Part of my problems include having a three level lumbar fusion in 2008. This prohibits me from sleeping in any position except supine because all other positions are too painful to sleep.

I absolutely have to sleep on my back only.

Thank you for the welcome!

Thewino

Your sleep study report could have been my sleep study report with a couple of exceptions. I didn't have many Hyponeas..mostly Obstructive Apnes.
My non REM sleep AHI was less than yours but my worst O2 drop went to 73%.
I too had extremely long REM latency (how long it takes you once you go to sleep to get to REM stage sleep...normal is around 90 minutes or so.)

Pressure needs depend on the airway tissues and how much pressure it takes to hold the airway open. Totally unrelated to how "severe" the AHI is. We did a poll a while back and there was a nice bell curve with the average pressure being 10 cm..so you are really very close to average.

Welcome to the forum. Some reading that you need to do to prepare yourself.
This one so you know what to expect from your DME...
http://maskarrayed.wordpress.com/what-y ... me-part-i/

This one about full data machines be sure to read but if you end up with a bilevel machine both the new Respironics PR S1 and ResMed S9 bilevel machines are full data machines. Concentrate on those two brands. They both offer excellent therapy, comprehensive data gathering and software that is easy to use.
http://maskarrayed.wordpress.com/

If you look in my signature I have a collection of hints...click on that link (if the darn thing will work right because it has been acting up) and check out the the 2 Pointers threads I have just done. It's a work in progress but it will example a lot of the questions you may have with software and the data seen.
Also in that collection is mollete's CPAP basics..as you have time read through it also. Lots of good stuff in there.

Edit: I see we have something else in common that messes with our sleep...pain.
We do what we have to do to manage the pain and get good quality sleep...sometimes not easy but we manage.

Welcome to the forum.

Pugsy,

Thanks a bunch for the warm welcome and needed advice. I've already been reading a lot on this site and it seems as if you might be the software expert so I may hit you up at a future date once I have my machine in-hand.

I want a data machine no matter which type of machine they finally recommend for me - so thanks for throwing the info on the bilevel machines in there.

I've read a little bit about the DME's. That sounds like its going to be a real fun day.

And, I will read what you have listed.

I'm appreciative.

Thewino

How did you get all your sleep study results? Did the doctor provide a copy for you? I don't think I received anything on paper yet I was diagnosed with severe sleep apnea.

Hey Chill,

When the sleep center called and stated I have severe obstructive sleep apnea and they wanted me to make another appointment to see if CPAP would be helpful to me, I told them I would be happy to make a second appointment if they sent the initial report to me.

I'm very detailed oriented and have all of my medical records. You have a right to all of your medical records so just ask the sleep center to mail you a copy.

My Rheumatologist ordered the sleep study. When I asked the sleep center to mail me a copy of the report, I asked if they would be kind enough to fax a copy to my primary physician. They were happy to oblige.

Be well,

TheWino

That was very good of them to mail and fax your copies of the report. Check to be sure you have the correct patient results. I had to go to the hospital's medical records dept and request the results myself. Unfortunately it was a comedy of errors. The initial study results were given to me with no problem. Then, when I went to get the results of the titration sleep results, they gave me another copy of the first results. I should've verified that they gave me the correct one. So, I went back and received the correct copy. For the asv study, I went back for my copy and they gave me the one from the second study. Again, thinking they were efficient, I left without checking to be sure. Now I have to make anther trip out there to be sure I get right study results for the third study (ASV). My fault, need to stop being so trusting and be proactive.