Study: SPLIT-NIGHT POLYSOMNOGRAM

Study: SPLIT-NIGHT POLYSOMNOGRAM

INDICATIONS

Mr. XXXXXXX is a 63-year-old gentleman with a history of obstructive sleep apnea syndrome, initially diagnosed in 1987 .  Recently, he has had problems poor quality sleep and daytime fatigue.  Mr. xxxxx presented for re-evaluation of the sleep, and he underwent split-night polysomnogram testing at Thomas Hospital Sleep Services on May 21, 2009. 

DIAGNOSIS

Obstructive sleep apnea syndrome

RESULTS

There were 7.4 hours of recorded time and 6.4 hours of sleep recorded.  Total sleep efficiency was 86%.  Three hours were spent in supine sleep position and 3.4 hours were spent in the side sleep positions.  Latency to sleep onset was mildly prolonged at 13 minutes.  Latency to stage REM onset was mildly prolonged at 93.5 minutes.  There were 18 awakenings for 49.5 minutes of awake time after sleep onset.  There was a mild increase in percentage of awake time in stage II sleep with reductions in the percentages of stage I and stage REM sleep .  No stage III, IV sleep was recorded.  The hypnogram revealed 2 periods of stage REM sleep including 1 well-maintained prolonged period of stage REM sleep in the supine position after the addition of C-Flex therapy.

The average sleeping heart rate was 61 beats per minute.  Variation in heart rate was seen with events of sleep-disordered breathing and arousals and there was an occasional PVC.  Moderate to loud snoring was heard and this decreased with titration of C-Flex therapy.  No periodic limb movement was scored.  Hemoglobin desaturations occurred to as low as 81% in the 1st portion of the study without CPAP therapy.  Hemoglobin desaturation resolved after the titration C-Flex therapy titrate over his pressures.  For 87% of sleep time, hemoglobin saturations remained greater than 89% in the study.

There were 146.5 minutes of moderate sleep time and 112 minutes of sleep time recorded without the benefit of CPAP therapy.  At this time, there were 47 obstructive apneas and obstructive hypopneas for a respiratory disturbance index of 25.2 consistent with a moderate severity of obstructive sleep apnea syndrome.  Mr. xxx was then fitted with a Respironics Comfort Classic size large full interface and C-Flex therapy was titrated over range of pressures from 4 to 13 cm of water.  The best results were stated at a C-Flex pressure setting of 10 cm of water and 96.5 minutes of sleep time were recorded at this pressure setting. At this time, there were no apneas and only 5 hypopneas for a respiratory disturbance index of 3.1, a marked improvement compared to the pretreatment respiratory disturbance index of 25.2.  Snoring was controlled and no hemoglobin desaturations occurred at pressure setting.  Mr. xxxxx was also able to maintain a prolonged period of stage REM sleep in the supine position at this pressure setting.

Mr. xxx awakened from the study, feeling much better rested than usual.  No medication was given to help a sleep onset or sleep maintenance.  Mr. xxx estimated it took about 10 minutes a fall asleep and then he awakened about 3 or 4 times before starting on CPAP and then he spent the rest of the night, sleeping an estimated total of 7 hours.  His blood pressure study onset was 107/62 on 103/61 at the end of the study.

RECOMMENDATIONS

I will review these results with Mr. xxx who recommended that he will be started C-Flex therapy at a pressure setting of 10 cm of water with a Respironics Comfort Classic full face mask size large with interface this choice.  I will ask him to return in a couple of weeks if he is having any initial problems with C-Flex therapy.