Diagnostic Analysis
Total Recording time 159.6
Totoal Sleep Time 150.2
Sleep Latency (min) 6.4
REM Latency (min) N.A
Sleep Efficiency (%) 94.1
Stage 1 (%TST) 76.7
Stage 2 (%TST) 23.3
Stage 3 (%TST) 0
Stage 4 (%TST) 0
REM (%TST) 0
Wakefulness (%TST) 2.0
Awakenings: 6
Total Apneas & Hypopneas: 312
Respiratory Arousals: 312
Respiratory Arousal Index: 124.6
Spontaneous Arousals: 1
Central Apneas 2
Obstructive Apneas 84
Mixed Apneas 0
Obstructive Hypopneas 226
Apnea Index 34.3
RDI 124.6
Lowest O2 Saturation % 84.3
Average O2 Saturation % 95.1
Total PLM events 21
PLM arousals 3
PLM Index 8.4

Treatment Analysis
Total Recording time 293.2
Total Sleep Time 244.9
Sleep Latency (min) 10.8
REM Latency (min) 158.5
Sleep Efficiency (%) 83.5
Stage 1 (%TST) 24.1
Stage 2 (%TST) 64.3
Stage 3 (%TST) 0
Stage 4 (%TST) 0
REM (%TST) 11.6
Wakefulness (%TST) 15.3
Awakenings: 10
Total Apneas & Hypopneas: 166
Respiratory Arousals: 166
Respiratory Arousal Index: 40.7
Spontaneous Arousals: 14
Central Apneas 0
Obstructive Apneas 2
Mixed Apneas 0
Obstructive Hypopneas 164
Apnea Index 05
RDI 40.7
Lowest O2 Saturation % 87.3
Average O2 Saturation % 97.5
Total PLM events 38
PLM arousals 6
PLM Index 9.3

Can someone please help me understand this, and if I need any more info on here.

Thank you in advance

Abrianas mom wrote:

Diagnostic Analysis
Total Recording time 159.6
Total Sleep Time 150.2
Sleep Efficiency (%) 94.1
Stage 1 (%TST) 76.7
Stage 2 (%TST) 23.3
Stage 3/4 (%TST) 0
REM (%TST) 0
Total Apneas & Hypopneas: 312
Respiratory Arousals: 312
Respiratory Arousal Index: 124.6
Obstructive Apneas 84
Obstructive Hypopneas 226
Apnea Index 34.3
RDI 124.6
Lowest O2 Saturation % 84.3
Average O2 Saturation % 95.1

Treatment Analysis
Total Recording time 293.2
Total Sleep Time 244.9
REM Latency (min) 158.5
Sleep Efficiency (%) 83.5
Stage 1 (%TST) 24.1
Stage 2 (%TST) 64.3
Stage 3/4 (%TST) 0
REM (%TST) 11.6
Total Apneas & Hypopneas: 166
Respiratory Arousal Index: 40.7
Obstructive Hypopneas 164
RDI 40.7
Lowest O2 Saturation % 87.3

An apnea is a reduction in air flow of at least 80%.  A hypopnea is a reduction in flow of 50-80% with a desaturation and/or an arousal, depending on the insurer.
I edited some stuff to concentrate on a few areas.
Short diagnostic.  This is a split study (all in one night)?
Stage 1 sleep is basically worthless, and should only be about 5% of the study.  So 77% is a big problem.
RDI of 124 is about as high as you can get.
In the diagnostic, you need the RDI detail for the pressures tried to see if there is an ideal pressure.  Try to get the titration table, that's important to determine treatment effectiveness.
The Stage 1 and 2 percentages have reversed, so that's good.  No 3/4, and still low REM, that might be an issue.
Those RDI, arousal and desaturation numbers are based on the whole titration period, which includes sub-optimal pressures.  Get the rest of the stuff and we'll see where you ended up.
sleepydave

Thanks SleepyDave,

I have the rest of the report, but do not understand anything.  Where do I find the Titration info?

Hi AM:
The titration table looks like this:



sleepydave

Here is the info, but couldn't get it to look as nice as yours.  Hopefully you understand it.  Thank you so much SD you have been such a great help for me.



Pressure (cmH20)    TRT    (min)    REM (min)    Non-Rem  (min)    Obstr. Apnea    Cent. Apnea    Mixed Apnea    Hypo-pneas    Total Events    Non-   REM    RDI    REM    RDI                     RDI    SaO2 High    SaO2 Low    SaO2 Mean
4    43.9    0    20.3    2    0    0    25    27    79.9    0    79.9    100.5    91.9    98.5
6    12.9    0    12.9    0    0    0    12    12    55.9    0    55.9    100.5    87.3    95.3
8    43.5    0    23    0    0    0    11    11    28.7    0    28.7    100.5    88.8    98
9    26.2    0    26.2    0    0    0    17    17    38.9    0    38.9    100.5    88.3    97.6
10    17.1    0    17.1    0    0    0    18    18    63.2    0    63.2    100.0    87.3    96
11    50.8    25.3    25.5    0    0    0    28    28    61.1    4.8    33.1    100.5    87.3    97.5
12    55.2    3.2    49    0    0    0    30    30    36.8    0    34.5    100.5    87.3    96.9
13    43.4    0    42.4    0    0    0    23    23    32.5    0    32.5    100.5    91.9    98.3

OK, let's try to get a better look at this:

Hi AM:
The goal of effective CPAP titration is to get at least below an AHI of 5.0.  And as you can see, you're really nowhere near that.  Yeah, it's better than 125, but there's more work to do.

What pressure are you getting set up on?

And what's with that cardiac stuff?  Was that second degree heart block you were thinking of?  How'd that turn out?

Your sleep architecture is obviously much better on CPAP, but this definitely needs follow up.  What is your MD's plan?

The AHI is quite refractory, and there is a hint that it is less severe in REM.  Hmmm, wonder if there's a touch of that complex sleep disordered breathing there.  But with hypopneas?  Not likely.

How's about any other significant medical issues or medications?

sleepydave

I am getting set up on 13 to 18 cm of water pressure on the APAP.  

They want to download from the machine in a month to ensure that hypopneic events are being obliterated.  She said that clinical followup will be important.  Also, an Overnight home oximetry may also be helpful to ensure an objetive, adequate response to therapy.  

What is the AHI?  

As far as other medical issues and medications.  I have hypothyroidism (TSH levels should be 3-5% mine are 66% and on 250 mcg of Synthroid (50 less than max they make)  

Because of the hypothyroidism I am overweight, which is new for me. I have always been about 5' 8" 140, but NO WAY not now.  (LOL)

In my eyes, I think a large part of this problem is my tonsils.  I have HUGE, and let me emphasize that even the doctor says they are the biggest tonsils she has seen.  ENT doctor said that he won't remove them though because I do not suffer from Strep several times a year.  (Now that I've had sleep study done, my GP doc is trying to convince ENT that I need them out)


Besides that I am healthy.

Quote:

And what's with that cardiac stuff? Was that second degree heart block you were thinking of? How'd that turn out?

I go to the GP tomorrow and she and I will discuss the cardiac stuff.  I still am unsure on that.  My results do not say anything except EKG artifact noted.

Hi AM:
The AHI is the apnea-hypopnea index, or number of apneas and hypopneas per hour.  When you use the term respiratory disturbance index, that would include any disturbance from a respiratory origin, like snores.  I think their RDI is really AHI.

OK, you've got a bunch of hypopneas, they should (although you can never really tell) have been taken care of by low level CPAP, but they weren't.  Thyroid supplements can destroy your sleep architecture, especially if you take them at night instead of the morning.  Is your hypothyroidism well-controlled, not overly treated?

What you have to hope is that the AutoCPAP will pick up the same events that the PSG did.  If the hypopneas in the study were more like a response to an issue (like an arousal, or central hypoventilation due to under-treated hypothyroidism) rather than being caused by OSA, those high AutoCPAP pressures are going to make everything worse.

Ever have a blood gas or electrolytes (particularly -HCO3 or Total CO2 level)?  And get the sleep architecture graph if you can.  And how much weight are we talking, here, whisper it my ear (***).

This might be more of an AutoBiPAP case than AutoCPAP.
sleepydave

I hate being a newbie at something LOL.  Its like a foriegn language.  Okay let's see.

Thyroid...I take my medicine first thing in the morning.  I am still very much "hypo" and have a feeling she is going to up my meds again.  I just did bloodwork today so I will know by next Tuesday.  I only see her every 8 weeks for Thyroid, and its been up'd the last 2 times I have seen her.

No, I do not think I have ever had a Blood Gas or Electrolytes, but not sure.  

I weigh 215, not ashamed since I know I am still "healthy as far as chloest/ everything else and know its from my Thyroid.  I just live for the day that its regulated and I go back to being 130-140

I got my machine but now I am waiting on a ff mask.  He brought me a nasal and I just can't use it.  (I am a mouth-breather day or night)

Hi AM:
Hypothyroidim still not controlled?  Hmmm...  Now, you can dig around in the literature and find a lot of stuff about an association between OSA and hypothyroidism, but it's tough to find anything that says TRT consistently turns OSA around completely.

But you've got a bunch of hypopneas there that are not particularly susceptible to CPAP, and I'm just wondering if they're more due to reduced breathing, or hypoventilation, rather than obstruction per se.  I mean, normally you wouldn't think that, but if your case of hypothyroidism is that bad, I'm wondering what the respiratory events actually look like on the PSG.  If they're more of a hypoventilation, then BiPAP, or AutoBiPAP might be a better choice.  And at high pressure (>13 cmH2O or so) a lot of people think one should be on BiPAP anyway.

If you can find your bicarb level in your electrolytes, that may offer some insight.

OK, so you got a machine, but try to get a download of the AutoCPAP maybe every week.  Let's see what turns up, it might be anything.  It could go to 20 every night.  It could also stay at low level if the breathing is simply hypoventilation.  And that in turn might change as the hypothyroidism is brought under better control.

I guess the gauge that you can look for in the short run would be, do you feel better on CPAP once it gets going.

What was the average length, longest length, etc. of the respiratory events?  That might be a clue.
Stay in touch.
sleepydave