please analyze OSCAR data, low ahi but sleepy

[beesamca]

Hi,
Diagnosed with mild OSA.
Two years on  AirSense 11. 
Low AHI but constant headache and daytime sleepiness is ruining my life.  

172 LB, Male, BMI 23. Good sleep hygiene.  

Please help analyze the attached OSCAR data.  I am hoping to improve my situation.  I am grateful for any help.

Thank you so much!

[jdougc]

Welcome to the forum, 
Please post a copy of your sleep report with your info redacted. 
Did you have CAs during your sleep study? If not, these CAs might be treatment emergent and will diminish.

Your minimum pressure is too low for an adult , raise it to at least 8.4 cm, same with the ramp, set it to 8 cm. 
8.4cm was your 95% on May 8th.
Set ramp to 5 minutes, as you should be used to therapy by now. 

Consider using lanilon to protect your nostrils and possibly help seal the P10 mask.

[beesamca]

Hi, thank you for your input. I am grateful for your help.

Here are the comments followed by the report.

During the split night sleep study performed on 4/24/2023, your overall Respiratory Disturbance Index was 25.8 events per hour and your AHI was 25.3 events per hour (*AHI 4% or greater: 4.0 events per hour). The lowest oxygen level noted was 88.0 %. The polysomnographic findings are consistent with moderate obstructive sleep apnea.

Continuous Positive Airway Pressure (CPAP) was applied during the night and your sleep apnea is best treated with auto CPAP at a pressure setting of 6 to 14 cm of water. The mask/interface used during your study was the Resmed AirFit P10 with small nasal pillows.

There were no signs of periodic leg movements [PLMS] during sleep.

A single lead ECG was monitored throughout the study, and did not reveal any cardiac issues.


SPLIT NIGHT POLYSOMNOGRAPHY REPORT

PATIENT'S NAME:
DOB:
WEIGHT: 183.0 lb
BMI: 25.5 kg/m2
DATE OF RECORDING: 4/24/2023

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CLINICAL BACKGROUND
39 year-old patient is here for Split Night Polysomnography to evaluate for a possible sleep disorder.

PROCEDURE:
This split night polysomnography montage using Polysmith Version 11.0 Software included recorded video, 6 EEG electrodes for frontal, central, and occipital monopolar recordings, 2 EOG electrodes, ECG, and chin EMG electrodes, snoring microphone, thermistor, airflow pressure, thoracic, and abdominal respiratory effort, pulse oximetry, leg movement, body sleeping position, and body movement. The 30 sec. epochs were scored according to The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications Version 2.5 (2018).

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DIAGNOSTIC PORTION:
Lights Out / On (clock times): Lights out: 21:21:38 / Diagnostic End: 23:59:03
Total Recording Time (TRT) (min): 157 minutes
Total Sleep Time (TST) (min): 121 minutes
Sleep Efficiency: 76.8 %
Sleep Latency (min): 12 minutes
Stage REM Latency (min): 87 minutes
Wake after sleep onset (WASO) (min): 24 minutes

Stage N1 Sleep (min, % of TST): 2.9 %
Stage N2 Sleep (min, % of TST): 87.2 %
Stage N3 Sleep (min, % of TST): 0.0 %
Stage R Sleep (min, % of TST): 9.9 %
Supine Sleep (min): 121.0 minutes
Arousals (index, #): 16.9 events/hr

RESPIRATORY ANALYSIS:
Apnea/Hypopnea Index (AHI): 25.3 events/hr
AHI (AHI /w Hypopnea events 4% desat or greater): 4.0 events/hr
NREM AHI: 20.4 events/hr
REM AHI: 70.0 events/hr
Non-Supine AHI: 0.0 events/hr
Supine AHI: 25.3 events/hr

Respiratory Disturbance Index (RDI): 25.8 events/hr
NREM RDI: 20.9 events/hr
REM RDI: 70.0 events/hr

Apneas (index, #): 3.5 events/hr
Obstructive Apneas (index, #): 3.0 events/hr
Mixed Apneas (index, #): 0.0 events/hr
Central Apneas (index, #): 0.5 events/hr
Hypopneas (index, #): 21.8 events/hr
RERAs (index, #): 0.5 events/hr

Mean Wake SpO2: 98.0 %
Mean Sleep SpO2: 96.0 %
Minimum Sleep SpO2: 88.0 %
Sleep Time with SpO2 < 88% (min, % of TST): 0.1 minutes - 0.1 %

Cheyne Stokes breathing: No
Snoring: Loud

CARDIAC ANALYSIS:
Mean Awake HR: 60 bpm
Mean Sleep HR: 60 bpm
Highest Sleep HR: 84 bpm

Bradycardia: No
Asystole: No
Sinus tachycardia: No
Narrow Complex Tachycardia: No
Wide Complex Tachycardia: No
Atrial Fibrillation: No
Other: No

LIMB MOVEMENT ANALYSIS:
Periodic Limb Movements of sleep (PLMS) (index, #): 0.0 events/hr
PLMS with arousals (index, #): 0.0 events/hr

OTHER ABNORMALITIES:
No other unusual body movements were demonstrated and no seizure activity was noted.

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SPLIT NIGHT START
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CPAP/BIPAP PORTION:
CPAP settings of 5 to 10 cm of water were used during the titration.

The patient was best fitted with a Resmed AirFit P10 with small nasal pillows.

SLEEP SCORING DATA:
Lights Out / On (clock times): CPAP Start: 23:59:03 / End Study: 05:55:41
Total Recording Time (TRT) (min): 356 minutes
Total Sleep Time (TST) (min): 336 minutes
Sleep Efficiency: 94.2 %
Sleep Latency (min): 00 minutes
Stage REM Latency (min): 54 minutes
Wake after sleep onset (WASO) (min): 13 minutes

Stage N1 Sleep (min, % of TST): 2.2 %
Stage N2 Sleep (min, % of TST): 62.9 %
Stage N3 Sleep (min, % of TST): 0.0 %
Stage R Sleep (min, % of TST): 34.8 %
Supine Sleep (min): 336.0 minutes
Arousals (index, #): 4.3 events/hr

RESPIRATORY ANALYSIS:
Apnea/Hypopnea Index (AHI): 6.8 events/hr
AHI (AHI /w Hypopnea events 4% desat or greater): 0.0 events/hr
NREM AHI: 2.2 events/hr
REM AHI: 15.4 events/hr
Non-Supine AHI: 0.0 events/hr
Supine AHI: 6.8 events/hr

Respiratory Disturbance Index (RDI): 6.8 events/hr
NREM RDI: 2.2 events/hr
REM RDI: 15.4 events/hr

Apneas (index, #): 0.0 events/hr
Obstructive Apneas (index, #): 0.0 events/hr
Mixed Apneas (index, #): 0.0 events/hr
Central Apneas (index, #): 0.0 events/hr
Hypopneas (index, #): 6.8 events/hr
RERAs (index, #): 0.0 events/hr

Mean Wake SpO2: 98.0 %
Mean Sleep SpO2: 98.0 %
Minimum Sleep SpO2: 95.0 %
Sleep Time with SpO2 < 88% (min, % of TST): 0.0 minutes - 0.0 %

Cheyne Stokes breathing: No

CARDIAC ANALYSIS:
Mean Awake HR: 61.0 bpm
Mean Sleep HR: 54.0 bpm
Highest Sleep HR: 78.0 bpm

Bradycardia: No
Asystole: No
Sinus tachycardia: No
Narrow Complex Tachycardia: No
Wide Complex Tachycardia: No
Atrial Fibrillation: No
Other: No

LIMB MOVEMENT ANALYSIS:
Periodic Limb Movements of sleep (PLMS) (index, #): 0.0 events/hr
PLMS with arousals (index, #): 0.0 events/hr

OTHER ABNORMALITIES:
No other unusual body movements were demonstrated and no seizure activity was noted.

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CLINICAL INTERPRETATION:

1. Polysomnographic findings are consistent with moderate Obstructive Sleep Apnea. The overall RDI was 25.8 events per hour of sleep and the AHI was 25.3 events per hour (*AHI 4% or greater: 4.0 events per hour). The lowest oxygen saturation was 88.0.
2. Loud snoring was present per the technician's notes.
3. Periodic limb movements of sleep were not significant.
4. A single lead ECG was monitored throughout the study, and did not reveal any cardiac issues.
5. The most efficacious treatment modality for sleep apnea is continuous positive airway pressure (CPAP) and surgical treatment modalities are alternative options. An oral appliance may be effective treatment in mild cases. Non-specific treatment options include weight loss of at least 10% of body weight (if overweight), avoidance of supine posture (i.e. side-sleeping or elevation of the head 30 degrees is preferred), and avoidance of sleep deprivation, alcohol and nicotine.

Patient appears to be best treated with nasal-auto CPAP at a pressure setting of 6 to 14 cm of water. This pressure may need to be adjusted after the patient is habituated to the equipment and physiology has become less abnormal.

A prescription is written for auto CPAP at a pressure setting of 6 to 14 cm of water.