SLEEP ANALYSIS REPORT

Name :  	CATRON, LAURA	10/19/2005		

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.  Nasal CPAP was applied using the patient's own autotitrating unit.  The total recording time was 407.6 minutes of which 352.5 minutes was sleep.  In comparison to the study of 10/18/05 while on CPAP titration, sleep efficiency has improved from 72.1% to 86.5%, REM sleep has declined from 14.9% to 14.6% and SWS has declined from 4.4% to 0.0%.  Overall, there were 36 respiratory events, of which 1 was an obstructive apnea and 35 were obstructive hypopneas.  The AHI for REM was 1.2, for NREM 7.0 and for sleep 6.1.  There were 5 desaturations with a nadir of 89.2%.  There were 84 PLMs with an index of 14.3.  The PLMs were moderate in nature.  There were 7 awakenings and 109 arousals.  36 of the arousals were associated with respiratory events, 24 were spontaneous in nature and 49 were associated with PLMs.  There was good control of all events at 11.0 cmH2O, where an AHI of 0.0 was noted. There were no arrhythmia observed.

My notes  (Laura aka "rested gal"):

Machine:      Puritan Bennett GoodKnight 420E autopap.  The hose I had with me unfortunately did not have the necessary sensor tube running through it.  We rigged up a  sensor line to put through the air hose.  The makeshift tubing was an "Argyle" hose, which has balloon-like areas every 36 inches, changing the sensor line diameter in two places.

When I later downloaded the 420E's data using Silverlining 3 software, it looked as if using  the Argyle tube with its odd diameter variations as a "sensor tube" impaired the machine's ability to read air flow correctly.  Pressure in the range I normally use ( 8 – 14 cm H2O) was swinging all over the place instead of staying down at the steady 8 or 9 the machine usually uses for me.  A high number of centrals (14!) were erroneously recorded on the autopap's data.  I actually was having none and generally see none on my overnight data at home.  The number of hypopneas (36) and apneas (4) noted by the machine was closer on target.  The sleep lab scoring noted 35 hypopneas and 1 apnea.  However the 420E with its normal sensor line always treats me more effectively than that, letting far fewer hypopneas through.  Generally I have 5 – 12 hypopneas in the course of a 6 hour night

I used the Argyle "sensor" line again at home several days later.  Wonder of wonders, it seemed to work fine. Got my usual results.  So, I don't know what caused so many non-existing centrals to appear on the 420E's software results during the night in the lab. 

Mask:  Aeiomed "Headrest" ("Aura") with medium nasal pillows; homemade straps.

Leak control:  Self-applied tape across lips to prevent mouth air leaks/mouth breathing.

Pillow:   PAPillow
Sleep Architecture

Time at Lights Off	11:42:24	
Time at Lights On	06:30:02	
Total Recording Time (TRT)	407.6  min.	
Total Sleep Period (TSP)	400.6  min.	
Total Sleep Time (TST)	352.5  min.	
Sleep Efficiency (SE)	86.5  %	
		
Sleep Onset Latency (SOL)	7.0  min.	
Number of Stage 1 Shifts	46	
Number of Stage Shifts	104	
Number of Awakenings	7	
		
Number of REM Periods	3	
REM Latency	176.5  min.	
REM Latency minus Awake	164.0  min.	

Sleep Stages

STAGES
	TIME
(min.)	TST
(%)	LATENCY
(min.)	
				
WAKE	45.6			
STAGE 1	49.5	14.0	7.0	
STAGE 2	251.5	71.3	1.0	
STAGE 3	0.0	0.0	N.A	
STAGE 4	0.0	0.0	N.A	
STAGE REM	51.5	14.6	176.5	

Respiratory Analysis:               NREM                         REM                       TOTAL                      INDEX

Central Apneas	0	0	0	0.0	
Obstructive Apneas	1	0	1	0.2	
Mixed Apneas	0	0	0	0.0	
Hypopneas	34	1	35	6.0	
Apneas + Hypopneas	35	1	36	6.1	

Respiratory Events With Arousals

PARAMETER	INDEX	TOTAL	
			
Total Events	6.1	36	
NREM	7.0	35	
REM	1.2	1	

Apnea Events

PARAMETER	CENTRAL	OBSTRUCTIVE	MIXED	TOTAL	
					
Number	0	1	0	1	
Index	0.0	0.2	0.0	0.2	
Mean Duration	N/A	42.4	N/A	42.4	
Longest Duration	N/A	42.4	N/A	42.4	
Occur in REM	0	0	0	0	
Occur in NREM	0	1	0	1	
REM Index	0.0	0.0	0.0	0.0	
NREM Index	0.0	0.2	0.0	0.2	

Hypopnea Events

PARAMETER	CENTRAL	OBSTRUCTIVE	MIXED	TOTAL	
					
Number	0	35	0	35	
Index	0.0	6.0	0.0	6.0	
Mean Duration	N/A	31.5	N/A	31.5	
Longest Duration	N/A	47.6	N/A	47.6	
Occur in REM	0	1	0	1	
Occur in NREM	0	34	0	34	
REM Index	0.0	1.2	0.0	1.2	
NREM Index	0.0	6.8	0.0	6.8	

Respiratory Events and Body Position		       RDI and REM/NREM Sleep

PARAMETER	INDEX	TOTAL		PARAMETER	INDEX	
						
Apneas and Hypopneas	6.1	36		REM RDI	1.2	
Supine Events	6.2	36		NREM RDI	7.0	
Non-Supine Events	0.0	0		Sleep RDI	6.1	

Arousal Analysis:           NREM             INDEX             REM             INDEX         TOTAL          INDEX

Total Arousals	101	20.1	8	9.3	109	18.6	
PLM’s	78	15.5	6	7.0	84	14.3	
PLM Arousals	48	9.6	1	1.2	49	8.3	
Respiratory Arousals	35	7.0	1	1.2	36	6.1	
Spontaneous Arousals	18	3.6	6	7.0	24	4.1	

PLMs and Sleep Stages

STAGES	PLM-AROUSAL INDEX	ALL-PLM
INDEX	PLM-AROUSAL TOTAL	ALL-PLM TOTAL	
					
Total Sleep	8.3	14.3	49	84	
Stage 1	6.1	12.1	5	10	
Stage 2	10.3	16.2	43	68	
Stage 3	0.0	0.0	0	0	
Stage 4	0.0	0.0	0	0	
Stage REM	1.2	7.0	1	6	

PLM Events With Arousals

PARAMETER	INDEX	TOTAL	
			
Total Events	8.3	49	
NREM	9.6	48	
REM	1.2	1	

PLM Events W/O Arousals

PARAMETER	INDEX	TOTAL	
			
Total Events	6.0	35	
NREM	6.0	30	
REM	5.8	5	

Oxygen Saturation

PARAMETER	AWAKE	NREM	REM	TOTAL RECORD	
					
Mean SaO2 %	97.2	97.4	97.3	97.4	
Min SaO2 %	89.7	89.2	95.1	89.2	
Max SaO2 %	99.0	99.0	99.0	99.0	
					
% Duration of SaO2 In Range :					
90 – 100 %	99.2	99.9	100.0	99.9	
80 – 90 %	0.0	0.1	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)	0.8	
Basal O2 during sleep	98.2	
Average low O2 during all desaturations	92.1	
Number of desaturations < 90	1	
Average duration of desaturations < 90	104.3	
Minimum O2 value	89.2	

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	
6.5	2.2	0.0	0.0	0	0	0	0	0	0.0	98.5	95.6	97.7	
7	80.2	10.0	53.9	1	0	0	8	9	8.4	99.0	89.2	97.2	
7.5	40.0	0.0	28.1	0	0	0	0	0	0.0	99.0	91.2	97.0	
8	81.6	0.0	70.9	0	0	0	5	5	4.2	99.0	92.2	97.5	
8.5	51.4	11.5	39.9	0	0	0	9	9	10.5	98.5	95.1	97.1	
9	93.8	20.3	72.0	0	0	0	7	7	4.6	99.0	92.6	97.7	
10	36.1	0.0	25.6	0	0	0	6	6	14.1	99.0	89.7	97.4	
11	17.8	9.7	7.6	0	0	0	0	0	0.0	98.0	95.6	97.9	
12	2.9	0.0	2.9	0	0	0	0	0	0.0	98.5	97.1	98.3	

RESPIRATORY EVENT SUMMARY

GRAPHIC SUMMARY