I tried to attach photo files of charts from study, but if not viewable maybe one can look at them in a Google doc here:
https://docs.google.com/document/d/1jfVX...sp=sharing
FINDINGS: Please refer to the attached summary for additional quantitative information.
DIAGNOSIS: Obstructive sleep apnea syndrome
IMPRESSION: A full night PAP titration polysomnogram was completed. PAP was initiated at a setting of 4cm H20 and increased from this setting. Best results were seen at a pressure of 6cm H20, where near-complete resolution of sleep apnea was observed. REM stage sleep was observed at this pressure. Cardiac bigeminy was noted.
RECOMMENDATIONS:
1. Initiate CPAP using a properly adjusted large ResMed AirTouch F20 mask, or fit to patient comfort, at a pressure of 6cm H2O with heated humidification.
2. Close clinical follow-up to ensure proper comfort and usage of PAP is paramount.
3. May consider nocturnal pulse oximetry once compliant on PAP to assess for the need of supplemental oxygen.
4. May consider consultation with otiaryngiogy for airway assessment and possible surgical options for improvement. May consider dental consult for possible mandibular device.
5. Counsel patient on risks of driving or operating heavy machinery when tired as well as the hazards of using alcohol or sedatives at bedtime.
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SLEEP CONTINUITY AND SLEEP ARCHITECTURE: Lights off was at 23:54: and lights on 05:55: (6.0 hours in bed). Total sleep time was 253.5 minutes (30.0% supine; 69.0% lateral; 0.0% prone, 13.0% REM sleep), with a decreased sleep efficiency at 70.0%. Sleep latency was decreased at 4.0 minutes. REM sleep latency was normal at 73.5 minutes. Of the total sleep time, the percentage of stage N1 sleep was 11.0%, stage N2 sleep was 75.9%, stage N3 sleep was 0.0%, and REM sleep was 13.0%. There were 4 Stage R periods observed on this study night, 22 awakenings (i.e. transitions to Stage W from any sleep stage), and 81.0 total stage transitions. Wake after sleep onset (WASO) time accounted for 104 minutes.
AROUSAL: There were 43 arousals in total, for an arousal index of 10.2 arousals/hour. Of these, 25 were identified as respiratory-related arousals (5.9/hr), 0 were PLM-related arousals (0.0/hr), and 17 were nonspecific arousals (4.0/hr)
RESPIRATORY MONITORING: Based on CMS criteria (using a 4% oxygen desaturation rule for scoring hypopneas), there were 16 apneas (5 obstructive; 10 central; 1 mixed), and 44 hypopneas. Apnea index was 3.8. Hypopnea index was 10.4. The apnea-hypopnea index was 14.2 overall (28.4 supine, 5.6 non-supine; 27.3 REM, 24.5 supine REM). There were 0 respiratory effort-related arousals (RERA). The RERA index was 0.0 events/hr. Total respiratory disturbance index (RDI) was 14.2 events/hr. RDI results showed: supine RDI 28.4/hr; non-supine RDI 8. 1/hr; REM RDI 27.3/hr, supine REM RDI 24.5/hr.
Based on AASM criteria (using a 3% oxygen desaturation and /or arousal rule for scoring hypopneas), there were 16 apneas (5 obstructive; 10 central; 1 mixed), and 45 hypopneas. Apnea index was 3.8. Hypopnea index was 10.7. The apnea-hypopnea index was 14.4 overall (28.4 supine, 5.8 non-supine; 29.1 REM, 24.5 supine REM). There were 0 respiratory effort-related arousals (RERAs). The RERA index was 0.0 events/hr. Total respiratory disturbance index (RDI) was 14.4 events/hr. RDI results showed: supine RDI 28.4/hr; non-supine RDI 8.5/hr; REM RDI 29.1/hr, supine REM RDI 24.5/hr.
Respiratory events were associated with oxyhemoglobin desaturations (nadir during sleep 75%) from a mean of 92%). There were 0 occurrences of Cheyne Stokes breathing.
LIMB MOVEMENTS: There were 0 periodic limb movements of sleep (0.0/hr), of which 0 (0.0/hr) were associated with an arousal.
OXIMETRY: Total sleep time spent at, or below 88% was 19.1 minutes, or 7.5% of total sleep time.
BODY POSITION: Duration of total sleep and percent of total sleep in their respective position is as follows: supine 76 minutes (30.0%), non-supine 177.5 minutes (70.0%); right 175 minutes (69.0%, left 00 minutes (0.0%, and prone 00 minutes (0.0%). Total supine REM sleep time was 22 minutes (66.7% of total REM sleep)
Comments
TREATMENT: CPAP was first started @ 4ch20 per patient request for comfort (wanted EPR as well, but explained that at such a low pressure EPR has no effect) and titrated to 12 cmh20 to eliminate the majority of respiratory events supine w/ a RESMED AIRTOUCH F20, LARGE mask (brought from home) ...Supine and lateral sleep was observed with most stable breathing occurring on his side.. The FFM did appear to help further block his airway when head is in a certain position, so may benefit from a nasal mask or positional therapy on lower pressures After waking up, patient struggled to tolerate 12 cmh20 so pressure was decreased to 7 cmh20. About 10 minutes later patient complain that 7cm was still too high to fall back asleep so decreased back to 4m EKG showed persistent premature beats
Whats good or bad about what my machine says?
my last nights airsense11 data says
pressure 6
leak 2L/min
AHI 9.0
Total AI 6.9
obstructive AI 5.8
central AI 1.1
annother night
Pressure 13.8
Leak 5L/min
AHI 5.4
Total AI 1.8
Obstructive AI 0.4
Central AI 1.3