STUDY : DIAGNOSTIC POLYSOMNOGRAM

STUDY : DIAGNOSTIC POLYSOMNOGRAM


INDICATIONS


Ms. xxxxx is a 51-year-old lady referred by Dr. xxxx from pulmonary and sleep disorders evaluation.  Please see Ms. Gray's history and physical dictation for details of the presentation.  Ms. Gray underwent standard diagnostic polysomnogram testing at Thomas Hospital Sleep Services on May 10, 2009, for evaluation of her poor quality sleep, history of snoring, and frequent awakenings and daytime hypersomnia.   

DIAGNOSES

1.     Obstructive sleep apnea syndrome (327.23).

2.     Periodic limb movement disorder (327.51).


RESULTS 

There were 7.5 hours of recorded time of 3.7 hours of sleep recorded.  Total sleep efficiency was poor at 50%, 51 minutes were spent in supine sleep position and 172.5 minutes were spent in the side sleep positions.  Latency of sleep onset was prolonged at 56 minutes.  Ms. Gray was given a 10 milligrams dose of Ambien to help with sleep onset and sleep maintenance.  Latency to stage REM onset was prolonged at 306.5 minutes.  There were 13 awakenings for 171 minutes of awake time after sleep onset.  There was an increase in percentage of awake time and decrease in the percentages of all sleep stages, especially stage REM sleep.  Hypnogram revealed frequent awakenings and long periods awakenings with 1 short period of stage REM sleep in the last 3rd of the study.

The average sleeping heart rate was 86 beats per minute.  Some variation in heart rate with events of sleep-disordered breathing and arousals.  An occasional PVC was seen.  Minimal snoring was heard.  There were 63 periodic limb movements scored and 6 of these events were associated with arousal while none were associated with awakening. Total PLM index was 16.9.  The PLM index with arousal was 1.6.  There were 133 obstructive respiratory events in 3.7 hours of sleep for a total respiratory disturbance index of 35.7.  The total arousal index was 38.1.  Events of sleep-disordered breathing occurred in both the supine and nonsupine sleep positions, but were much more frequent during the short period of supine sleep.  The supine respiratory disturbance index was 98.6 compared to 19.5 in the nonsupine sleep position.  Occasional hemoglobin desaturations occurred to as low as 75%.  For 99% of sleep time, hemoglobin saturations were greater than 89%.

Ms. Gray awakened from the study feeling "tired."  She estimated that it took "hours" to fall asleep and that she awakened 4 times during the night, sleeping an estimated 4 hours.  Blood pressure study onset was 102/66 and 110/72 at the end of the study. 

RECOMMENDATIONS 

I will review these results with Ms. Gray 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.  The periodic limb movement disorder will be re-evaluated in that upcoming study.