Well, now I am in need of some help.
I had a PSG just over two weeks ago, and I had the follow-up consultation a couple of days ago. I'll cut-and-paste the synopsis of the test results. (I apologize for the length and the routine 'boiler-plate' stuff...)
"___ ______ , M.D. 6/15/2021 4:43 PM
Technical summary: The patient underwent a CPAP titration. This
was a 16 channel montage study to include a 6 channel EEG, a 2
channel EOG, and chin EMG, left and right leg EMG, a snore
channel, and a CFLOW pressure transducer. Respiratory effort
was assessed with the use of a thoracic and abdominal monitor and
overnight oximetry was obtained. Audio and video recordings were
reviewed. This was a fully attended study and sleep stage scoring
was performed. The test was technically adequate.
"Interpretation:
Study start time was 09:38:39 PM. Diagnostic recording time was
8h 37.0m with a total sleep time of 5h 30.5m resulting in a sleep
efficiency of 63.93%%.
Sleep latency from the start of the study was 12 minutes and the
latency from sleep to REM was 79 minutes.
In total,86 arousals were scored for an arousal index of 15.6.
"Respiratory:
There were a total of 1 apneas consisting of 1 obstructive
apneas, 0 mixed apneas, and 0 central apneas. A total of 36
hypopneas were scored.
The apnea index was 0.18 per hour and the hypopnea index was 6.54
per hour resulting in an overall AHI of 6.72.
AHI during rem was 23.1 and AHI while supine was 0.00.
"Oximetry:
There was a mean oxygen saturation of 93.0% with a minimum oxygen
saturation of 86.0%. Time spent with oxygen saturations below 89%
was 1.9 minutes.
"Cardiac:
The highest heart rate seen while awake was 86 BPM while the
highest heart rate during sleep was 79 BPM with an average
sleeping heart rate of 66 BPM.
"Limb Movements:
There were a total of 0 PLMs during sleep, of which 0 were PLMS
arousals. This resulted in a PLMS index of 0.0 and a PLMS arousal
index of 0.0.
"CPAP was tried from 6 to 13cm H2O.
"CPAP Titration: The PAP titration was initiated with CPAP 6 cm
of water and the pressure which was slowly titrated up in an
attempt to eliminate sleep disordered breathing and snoring. The
final pressure tested during the study was CPAP 13 cm water and
at this final pressure the patient was not observed in the supine
or REM sleep stage. The apnea hypopnea index improved to 1.6 per
hour and O2 nadir 90%. He spent 0.3 % of sleep time below 89% O2
saturation. Snoring was resolved. The patient utilized medium
N30i mask with heated humidification. The CPAP was well-tolerated
and there were minimal air leaks. No supplemental oxygen was
required.
"Impression:
1. Obstructive sleep apnea
"Recommendations:
I recommend CPAP 13 cm with N30i mask. Recommended 30 day
compliance download to assess the efficacy of the recommended
pressure and compliance for further outpatient monitoring and
management of CPAP therapy. In some cases alternative treatment
options may prove effective in resolving sleep apnea and these
options include upper airway surgery, the use of a dental
orthotic or weight loss and positional therapy. Clinical
correlation is required. In general patients with sleep apnea are
advised to avoid alcohol and sedatives and to not operate a motor
vehicle while drowsy and are at a greater risk for cardiovascular
disease."
My point of view is that is was another not-very-good test. I slept little, less than the reported 5hrs 30min.
The sleep doctor who ordered this test and consulted with me in the follow-up appointment, is new to me and I have only been in his care for about three months. So far, I am favorably impressed by this new-to-me physician. I told him the my sleep during the lab PSG was very non-representative, and the he understood.
His suggestion for treatment is CPAP at a pressure of 11cm and EPR that is comfortable, and use of a full face mask.
I have slept two nights using that prescription. I'll post the two nights' reports below.
Wed night's sleep stated with a significant de-saturation.
The wave form of the hypoxic period looks to me like impaired breathing, and the flow limitations were high. Below is a detail of the transition to more normal breathing. (OK, i'll attach it in the next post...)
