DIAGNOSTIC POLYSOMNOGRAM

DIAGNOSTIC POLYSOMNOGRAM

INDICATIONS

Ms. xxxxx is a 79-year-old lady referred for sleep disorders evaluation.  Please see Ms. Miller's history and physical dictation with recent office notes for details of the presentation.  Ms. Miller underwent standard diagnostic polysomnogram testing at Thomas Hospital Sleep Services for evaluation of poor quality sleep, daytime fatigue and hypersomnia and suspected obstructive sleep apnea syndrome. 

DIAGNOSES

1.  Obstructive apnea syndrome, severe (327.23)

2.  Periodic limb movement disorder (327.51).

 

RESULTS

There were 7.7 hours of recorded time, and 5.1 hour of sleep recorded.  Total sleep efficiency was mildly reduced at 66%.  Latency to sleep onset was prolonged at 43.5 minutes.  No medication was given to help with sleep onset or sleep maintenance.  Latency to stage REM onset was shortened at 65 minutes.  There were over 30 awakenings for 110 minutes of awake time after sleep onset.  There was an increase in percentage of awake time in stage I sleep, and a mild increase in percentage of stage III or IV sleep.  There were reductions in the percentages of stage II and stage REM sleep. Hypnogram revealed very frequent awakenings and difficulty maintaining sleep stages with one well-maintained period of stage REM sleep in the last 3rd of the study.

The average sleeping heart rate was 60 beats per minute.  Rare PVC and PAC were seen.  There was mild variation of heart rate and sleep-disordered breathing.  Mild to moderate snoring was heard.  There were 142 periodic limb movements scored and 25 of these events were associated with arousal.  Two events were associated with awakening.  The total PLM index was 27.9 and the PLM index with arousal was only 4.9.  There were 169 obstructive respiratory events and 5.1 hours of sleep for a total respiratory disturbance index of 33.2.  Hemoglobin desaturations occurred to as low is 79%.  Hemoglobin saturations remained greater than 89% for only 8.7% of sleep time.  Events of sleep-disordered breathing were more frequent during supine sleep.  The supine respiratory disturbance index was 76.2 compared to 28.2 for the nonsupine sleep position.  The stage REM apnea-hypopnea index was 41.3.

Ms. Miller awakened from the study feeling "still sleepy."  She estimated that it took about 60 minutes to fall asleep and that she awakened 3 times during the night, sleeping an estimated 6 hours.  Her blood pressure study onset was elevated at 150/65 and remained elevated at 160/75 at the end of the study.

RECOMMENDATIONS

I will review these results with Ms. Miller and recommend that she return for a 2nd polysomnogram with the addition and titration of C-flex therapy for treatment of her sleep-disordered breathing and related problems.  His periodic limb movement disorder will be re-evaluated in that upcoming study.