(11-26-2015, 09:21 PM)BoyertownCasket Wrote: Thank you for your reply and the relevant information within. Yes, I will sanitize a copy and post it. Thanks again for your reply.
This is a conventional polysomnographic study performed during the patient’s habitual sleep period in accordance with standards established by the American Academy of Sleep Medicine. Parameters include bilateral electrooculographic tracings; electroencephalographic tracings (modified 10-20 electrode configuration, featuring bilateral frontal, central and occipital leads); surface electromyography of submental musculature and bilateral anterior tibialis muscles; thoracic and abdominal respiratory impedance belt recordings; airflow measurements using oro-nasal thermister and nasal pressure transducer; electrocardiography; arterial oxygen hemoglobin saturation via finger pulse oximetry; and snoring. “Hypopnea” is defined by this center as a 30-70% decrease in airflow or respiratory effort lasting 10 seconds or longer in association with a 4% or greater oxygen desaturation.
Clinical Polysomnograpy Sleep efficiency was reduced at 62.5%. Out of 471.8 minutes in bed the patient slept for 295 minutes. Sleep architecture was abnormal. Sleep latency was normal at 29.5 minutes. There was 21.2% Stage N1, 66.4% Stage N2, 0% Stage N3, and 12.4% Stage R sleep. REM latency was prolonged at 218 minutes. There were 43.0 total awakenings during the night of less than 10 minutes and 0 awakenings which were greater than ten minutes in length. There were 2 REM periods. In addition to awakenings, there were 276.0 arousals from all causes for an arousal index of 56.1 per hour. Respiratory Parameters There were a total of 230 respiratory events (17 obstructive apneas, 132 hypopneas, 14 mixed apneas, 16 central apneas and 51 Respiratory Effort Related Arousals.) The Apnea-Hypopnea Index(AHI) was 36.4 events per hour and the Respiratory Disturbance Index(RDI) was 46.8 events per hour.
The longest event was 55.2 seconds in length and the average event was 17.7 seconds in length. In the supine position, the AHI was 89.8 events per hour. The patient was aroused 243 times due to respiratory events including snoring for a respiratory arousal index of 49.4 events/hour. Baseline O2 Saturation was 91.2. Nocturnal oxyhemoglobin saturation was normal . Minimum O2 Saturation was 84 %. In all, the patient spent 30.8 minutes with saturations below 89%. O2 Saturation Total Recorded (min) % of Recording 95% - 100% 12.0 2.5 90% - 94.9% 309.0 65.5 85% - 89.9% 145.1 30.7 80% - 84.9% 0.1 0.0 75% - 79.9% 0.0 0.0 70% - 74.9% 0.0 0.0 65% - 69.9% 0.0 0.0 60% - 64.9% 0.0 0.0 55% - 59.9% 0.0 0.0 50% - 54.9% 0.0 0.0 Time < 95% 454.1 96.3 Time < 90% 145.2 30.8 Moderate snoring was heard during the study.
Movement Analysis There were 103 total periodic limb movements during the sleep period for a PLM index of 20.9 events per hour. The patient was aroused 14 times due to PLMs for a PLM arousal index of 2.8 events/hour. Heart Rhythm Analysis The baseline heart rhythm was normal sinus. Also noted were occasional premature ventricular contractions Diagnosis and Impressions: 1. Severe Obstructive Sleep Apnea Syndrome – 780.53-0 2. Moderate Periodic Limb Movement Disorder – 780.52-4 3.
Nocturnal Arrhythmias Impressions and Treatment Recommendations:
1. Due to the severity of this patient's sleep apnea, the patient should be returned to the laboratory for a trial of Positive Airway Pressure Therapy.
2. Although Periodic Leg Movements were seen on this study, they are not causing significant sleep fragmentation or high numbers of arousals. Treatment of the patient’s periodic limb movement disorder is not recommended at this time.
3. Follow up in the Sleep Disorders Center to discuss the results of this study.