C-FLEX TITRATION POLYSOMNOGRAM

INDICATIONS

Mr. Michael J. Ederer is a 40-year-old gentleman referred for pulmonary and sleep disorders evaluation.  Please see Mr. Ederer's history and physical dictation for details of his presentation.  Mr. Ederer's diagnostic polysomnogram revealed a moderate severity obstructive sleep apnea syndrome.  That study also revealed supine worsening of sleep-disordered breathing and intermittent hemoglobin desaturation associated with sleep-disordered breathing.  Mr. Ederer returns for a 2nd polysomnogram with the addition and titration of C-flex therapy for treatment of his obstructive sleep apnea syndrome and related problems.

DIAGNOSIS

Obstructive sleep apnea syndrome, moderate severity (327.23).

RESULTS

There were 7.9 hours of recorded time and 7.4 hours of sleep recorded.  Total sleep efficiency was normal at 94%.  A 358 minutes of sleep time recorded in the supine position and 88 minutes were recorded in the nonsupine sleep position.  Latency to sleep onset was shortened at 6 minutes, suggesting hypersomnia.  Latency to stage REM onset was prolonged at 123 minutes.  There were 17 brief awakenings for 21 minutes of awake time after sleep onset. There was a decrease in the percentages of stage III, IV, and stage REM sleep and an increase in percentage of stage II sleep.  Compared to the diagnostic polysomnogram, there was an increase in percentages of stage III and stage IV sleep.  Hypnogram revealed several awakenings and 4 short periods of stage REM sleep.

The average sleeping heart rate was 64 beats per minute.  Mild variation of heart rate was seen with events of sleep-disordered breathing and arousals. A rare PVC was seen; 41 periodic limb movements were scored, but only 2 of these events were associated with arousal and none were associated with awakening. Total PLM index was 5.5 and the PLM index with arousal was only 0.3.

Mr. Ederer was fitted with a Respironics ComfortGel, size small interface and C-flex therapy was titrated over range of pressures from 4 to 11 cm of water.  Mr. Ederer showed improvement at all C-flex pressures tested and the best results were seen at a C-flex pressure setting of 9 cm of water, 68 minutes of sleep time was recorded at this pressure setting and there were no apneas and no hypopneas scored for respiratory disturbance index of 0.  This is a marked improvement compared to the pretreatment respiratory disturbance index of 22.5.  In addition, he was able to enter a short period of stage REM sleep in the supine position at this pressure setting.  Snoring was controlled and no hemoglobin desaturations occurred at this pressure setting.  Mr. Ederer also did well at C-flex pressure settings of 7, 8, and 10 cm of water.

Mr. Ederer awakened from the study, feeling "better than usual."  He estimated that it took about 3 minutes to fall asleep and he awakened 4 times during the night, sleeping an estimated 8 hours.  His blood pressure study onset was 133/75 and 129/72 at the end of the study.

RECOMMENDATIONS

I will review these results with Mr. Ederer and recommend to begin a trial of C-flex therapy at a pressure setting of 9 cm of water with a Respironics ComfortGel size small interface or the interface of his choice. I will ask him to return in a couple of weeks to see if he was having any initial problems with C-flex therapy.