SLEEP ANALYSIS REPORT

Name :  	CATRON, LAURA	10/18/2005		

Recording Technician Comments:
Patient seen in the Sleep Laboratory for nocturnal polysomnogram and CPAP titration.  Procedure explained, standard montage employed, including the appropriate sensors for the continuous recording of EOG, EEG, EMG of the chin and anterior tibialis muscles, EKG, respiratory movements of the chest, abdomen and air flow at the nose and mouth, pulse oximetry, body position and tracheal sound.  The patient was calm and cooperative throughout.  The study was continuously observed by a technician and recorded via infrared video photography.

Scoring Technician Comments:
The patient was fitted with a medium mask and headgear.  Nasal CPAP was initiated at minimal (4.0 cmH20) to assess patient tolerance, which was good.  The total recording time was 422.7 minutes of which 304.7 minutes was sleep.  In comparison to the study of 10/17/05 while on ambient pressure, sleep efficiency has declined from 79.8% to 72.1%, REM sleep has improved from 13.0% to 14.9% and SWS has declined from 6.2% to 4.4%.  Overall, there were 34 respiratory events, of which 2 were obstructive apneas and 32 were obstructive hypopneas.  The AHI for REM was 1.3, for NREM 7.6 and for sleep 6.7.  Positional dependency was exhibited, with an AHI of 10.5 while the patient was supine versus 0.0 in non-supine positions.  There were 5 desaturations with a nadir of 90.7%.  There were 149 PLMs with an index of 29.3.  The PLMs were severe in nature.  There were 22 awakenings and 94 arousals.  34 of the arousals were associated with respiratory events, 14 were spontaneous in nature and 46 were associated with PLMs.  There was good control of all events at 8.0 cmH2O, where an AHI of 0.0 was noted. There were no arrhythmia observed.

My notes  (Laura aka "rested gal"):

Titration:  Okay, second night and time to find what pressure works best to keep my throat open.  I went to sleep all wired up again, but this time wearing a mask and receiving treatment from the lab's Synchrony machine.  Taped my mouth as usual.  I used my own tried and true mask rather than any the sleep lab would normally provide.  Actually, no sleep lab in the world would have a mask like mine, as I've customized it pretty drastically.  Works for me!  :-)  A picture of how I've modified my Aeiomed "Headrest" mask (formerly known as an "Aura") is here:  http://www.tnlc.com/Lara/laura/osa/aura-SawPlastic2.jpg

Pressure:  Well, the first pressure on me was the pressure of, "I want to sleep steadily for this!" But, I guess the excitement of the whole study idea was finally getting to me.  I went to sleep easily and slept three hours.  The last four hours were spent fitfully waking up a lot.  At one point during a solid one hour "awake" stretch, I heard the sound of the lab's machine drop down a bit.  Smiled to myself (as best one can smile with mouth taped) thinking, "I know what that is....tech is lowering the pressure a notch, probably hoping that will help me go back to sleep, but the pressure isn't bothering me.  I'm just not sleepy!!"  And that was with Ambien!  I've never used any sleeping aid, ever.  But I took a 10 mg Ambien each night for the studies, "just in case."  In retrospect, once fifteen minutes or so had gone by, I should have done what I'd do at home on the rare occasions I wake up and don't go right back to sleep.  I should have sat up, turned on a light, and read the book I brought until I got sleepy again.  Probably if I'd wasted 20 minutes reading, I wouldn't have wasted the whole last half of the titration night with so many wake-ups.  Ah well, hindsight. 

At any rate, I did sleep enough for them to find a pressure that works well for me.  8 and 9 are the pressures every autopap I've used have come up with as effective most of the time.

Sleep Architecture

Time at Lights Off	00:11:46	
Time at Lights On	07:14:30	
Total Recording Time (TRT)	422.7  min.	
Total Sleep Period (TSP)	419.7  min.	
Total Sleep Time (TST)	304.7  min.	
Sleep Efficiency (SE)	72.1  %	
		
Sleep Onset Latency (SOL)	3.0  min.	
Number of Stage 1 Shifts	60	
Number of Stage Shifts	151	
Number of Awakenings	22	
		
Number of REM Periods	3	
REM Latency	83.0  min.	
REM Latency minus Awake	83.0  min.	

Sleep Stages

STAGES
	TIME
(min.)	TST
(%)	LATENCY
(min.)	
				
WAKE	114.5			
STAGE 1	61.7	20.3	3.0	
STAGE 2	184.0	60.4	1.0	
STAGE 3	13.5	4.4	15.5	
STAGE 4	0.0	0.0	N.A	
STAGE REM	45.5	14.9	83.0	

Respiratory Analysis:               NREM                         REM                       TOTAL                      INDEX

Central Apneas	0	0	0	0.0	
Obstructive Apneas	2	0	2	0.4	
Mixed Apneas	0	0	0	0.0	
Hypopneas	31	1	32	6.3	
Apneas + Hypopneas	33	1	34	6.7	

Respiratory Events With Arousals

PARAMETER	INDEX	TOTAL	
			
Total Events	6.7	34	
NREM	7.6	33	
REM	1.3	1	

Apnea Events

PARAMETER	CENTRAL	OBSTRUCTIVE	MIXED	TOTAL	
					
Number	0	2	0	2	
Index	0.0	0.4	0.0	0.4	
Mean Duration	N/A	23.5	N/A	23.5	
Longest Duration	N/A	24.1	N/A	24.1	
Occur in REM	0	0	0	0	
Occur in NREM	0	2	0	2	
REM Index	0.0	0.0	0.0	0.0	
NREM Index	0.0	0.5	0.0	0.5	

Hypopnea Events

PARAMETER	CENTRAL	OBSTRUCTIVE	MIXED	TOTAL	
					
Number	0	32	0	32	
Index	0.0	6.3	0.0	6.3	
Mean Duration	N/A	33.4	N/A	33.4	
Longest Duration	N/A	80.2	N/A	80.2	
Occur in REM	0	1	0	1	
Occur in NREM	0	31	0	31	
REM Index	0.0	1.3	0.0	1.3	
NREM Index	0.0	7.2	0.0	7.2	

Respiratory Events and Body Position		       RDI and REM/NREM Sleep

PARAMETER	INDEX	TOTAL		PARAMETER	INDEX	
						
Apneas and Hypopneas	6.7	34		REM RDI	1.3	
Supine Events	10.5	34		NREM RDI	7.6	
Non-Supine Events	0.0	0		Sleep RDI	6.7	

Arousal Analysis:           NREM             INDEX             REM             INDEX         TOTAL          INDEX

Total Arousals	92	21.3	2	2.6	94	18.5	
PLM’s	141	32.6	8	10.5	149	29.3	
PLM Arousals	45	10.4	1	1.3	46	9.1	
Respiratory Arousals	33	7.6	1	1.3	34	6.7	
Spontaneous Arousals	14	3.2	0	0.0	14	2.8	

PLMs and Sleep Stages

STAGES	PLM-AROUSAL INDEX	ALL-PLM
INDEX	PLM-AROUSAL TOTAL	ALL-PLM TOTAL	
					
Total Sleep	9.1	29.3	46	149	
Stage 1	11.7	18.5	12	19	
Stage 2	10.8	36.5	33	112	
Stage 3	0.0	44.4	0	10	
Stage 4	0.0	0.0	0	0	
Stage REM	1.3	10.5	1	8	

PLM Events With Arousals

PARAMETER	INDEX	TOTAL	
			
Total Events	9.1	46	
NREM	10.4	45	
REM	1.3	1	

PLM Events W/O Arousals

PARAMETER	INDEX	TOTAL	
			
Total Events	20.3	103	
NREM	22.2	96	
REM	9.2	7	

Oxygen Saturation

PARAMETER	AWAKE	NREM	REM	TOTAL RECORD	
					
Mean SaO2 %	96.2	95.7	95.3	95.8	
Min SaO2 %	93.7	90.7	91.2	90.7	
Max SaO2 %	98.5	97.6	97.1	98.5	
					
% Duration of SaO2 In Range :					
90 – 100 %	98.7	99.9	100.0	99.6	
80 – 90 %	0.0	0.0	0.0	0.0	
70 – 80 %	0.0	0.0	0.0	0.0	
60 – 70 %	0.0	0.0	0.0	0.0	
50 – 60 %	0.0	0.0	0.0	0.0	
Below 50 %	0.0	0.0	0.0	0.0	

Desaturations

Percent desaturation required	4	
Total number of desaturations	5	
Desaturation Index ( / hr)	1.0	
Basal O2 during sleep	97.2	
Average low O2 during all desaturations	91.6	
Number of desaturations < 90	0	
Average duration of desaturations < 90	N/A	
Minimum O2 value	90.7	

Pressure Level Analysis

Pressure
(cm H2O)	TRT
(min)	REM
(min)	Non-REM
(min)	Obstr.
Apnea	Cent.
Apnea	Mixed
Apnea	Hypo-pneas	Total Events	
RDI	SaO2
High	SaO2
Low	SaO2
Mean	
4	37.6	0.0	34.7	0	0	0	7	7	12.1	97.6	93.2	95.3	
6	20.2	0.0	20.2	1	0	0	12	13	38.6	97.1	90.7	95.2	
7	22.0	0.0	22.0	1	0	0	5	6	16.3	96.6	91.2	95.2	
8	77.3	24.5	41.8	0	0	0	0	0	0.0	97.6	91.2	95.4	
9	215.0	3.0	121.1	0	0	0	7	7	3.4	98.5	91.7	96.1	
11	30.3	5.9	16.4	0	0	0	1	1	2.7	97.1	93.7	95.8	
13	20.1	12.1	3.0	0	0	0	0	0	0.0	97.6	94.1	95.9	

RESPIRATORY EVENT SUMMARY

GRAPHIC SUMMARY