[Diagnosis] Questions on sleep study - Arousal Index

[Mountain Head]

Just got my PSG study results back (along w/ a new APAP).

I've got a bunch of questions, but will lay out just a couple of them, here, now.

My AHI was 20.7.  However, my total Arousal Index (AI) was 42.6 (20.1 Rera, and the rest snoring, PLM, and spontaneous).   42.6 (per hour) sounds high... and the last time I had a test in 2007, and do not remember there being a non-AHI component to the total number.  So, is this number (AI) considered high?  Is this problematic?  The report did say, "Sleep was severely disrupted." 

I guess my question is around whether the non-AHI arousal component is something about which to worry?  My guess is it is, but it looks like RERA/AI isn't what is used to determine whether therapy is necessary. 

Another questions is related to what appears to be really poor attention to detail on the scoring-report.  For instance, in one place, the report notes, "the amount of sleep time spent below SPO2 of 90% was 15.4%."  In another place of the report, it states that, "total amount of sleep time spent below SPO2 of 90% was 4.9%."  In a third place, it says, "Minutes SaO2 <90% = 15.4."  In a fourth place, it says, "%TST SaO2 < 90% = 4.9%.  Either I am not getting something (like, e.g., understanding the delta between SaO2 and SPO2) or someone has been incredibly sloppy in writing up this report.  Does anyone have any suggestions/comments?   Part of me wants to call the doc and have this re-scored/written.

Report also states that the nadir SPO2 was 90%, which begs the question around how I spent any time at a SPO2 or less than 90% when the lowest level I hit was 90%???

I know AHI tends to be worse when one in supine, but in my case this isn't the case.  AHI (supine) was 18.5; AHI (left side) was 11.5; and AHI (right side) was 93.8.   Does this sound way off?

My main issue with the report is it appears really sloppy, inconsistent, and in some places contradictory.  Is this just how these things are normally scored and written?  (Surprisingly, UW/Harborview sends their data out for scoring; that is, their own techs do not score the reports.)  I mean, the doc signed off on this with these inconsistencies.  Should I be concerned - has this been handled like a widget on a factory assembly line??

thanks, everyone!

David

[Walla Walla]

I would make an appointment to see the Doctor and ask him for a full explanation of your test results when you see them.

[sheepless]

SpO2 simply means that the SaO2 was measured using pulse oximetry. Very simply, SpO2 is an indirect measurement of the oxygen content of blood (oximetry) where Sao2 is a direct measurement of the oxygen content of the blood (arterial blood gas sampling).Dec 10, 2007
SpO2 vs. SaO2 ? | allnurses
https://allnurses.com/nursing-student-as...66863.html

I'm not an expert but this is my understanding:
ahi is average apnea and hypopnea per hour. these directly and negatively affect our health. arousals are less harmful in direct terms (e.g., may not result in low O2, stress the heart, etc. nearly as much as apnea) but to the extent they contribute to sleep deprivation it is desirable, to say the least, to address them. in my limited experience, sleep docs deal with apnea and hypopnea; we have to press for help with flow limitations, snoring, restless legs, periodic leg movement, etc.

[Mountain Head]

Thanks, guys!

[Mogy]

"My main issue with the report is it appears really sloppy, inconsistent, and in some places contradictory.  Is this just how these things are normally scored and written?  (Surprisingly, UW/Harborview sends their data out for scoring; that is, their own techs do not score the reports.)  I mean, the doc signed off on this with these inconsistencies.  Should I be concerned - has this been handled like a widget on a factory assembly line??"

With the reports they typically break them up as far as REM sleep, NREM sleep, supine sleep, non supine sleep. You can have several values for AHI and SpO2 and whatever else they are measuring. It can be confusing the first time reading them. If you post your report, several posters here can tell you whether there are inconsistencies.