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Help with understanding information in reports
I don't yet have the technician reports with the condensed graphs, however, I did just receive my small titration report. I find some of the information in it odd, given the results of my original sleep study. I know that it is better to share the more informative longer report, but here are highlights from what I have now.
Original sleep study: (highlights)
sleep time of 172 minutes with an efficiency of 40.9%
REM not recorded
Sleep archictecture showed 12.8% stage 1, 82.2% stage 2, 0% for slow wave, 0% for REM
220 respiratory events total
20 Central Apneas
94 Obstructive Apneas
93 Hypopneas,
1 mixed apnea
12 respiratory effort related arousals.
rdi 77
AHI 73
Longest obstructive apnea 26 seconds
Min ox saturation 76%, mean oxygen saturation 92%
During sleep time, the SaO2 was below 90% for 20.8 minutes
19 spontaneous arousals
Think that is most of the important stuff
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Here are some highlights of titration (using two different masks) study which to this newbie layperson seem inconsistent with the above findings:
Total recorded time was 372 minutes.
EEG confrimed sleep time was 128 minutes with sleep efficiency of 36%
Sleep maintenance efficiency was 40%
REM Latency was 286 (???)
Sleep architecture showed 4.7% stage 1, 75.8% stage 2, 0% slow wave sleep and 19.5% REM sleep.
Wake after sleep onset time was 190 minutes.
Inspection of the tracing shows no apnea at any pressure (HELLO????), but thye technician had a difficult time titrating, and snoring ultimately led to a pressure of 17 cm. A pressure of 16 com clearly abolished apnea.
A pressure as low as 8 cm was probably adequate, but there were some desaturations.
Recommendation is to start patient of an auto-titrating CPAP with a low pressure of 8 cm an a high pressure of 17 cm with heated humidification. The CPAP device can be subsequently interrogated for further information.
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So, please correct me if I am misunderstanding but this seems to say that the titration study was pretty worthless yielding no usable results so we are going to use an auto titrating machine to figure this out??
And, give the huge number of apneas in the first sleep study, how is it that they couldnt find even one apnea in the titration study?
Thanks for any observations or further questions I should be asking. I meeting with an RT on Monday (yippeeee!!!)
Thanks much
Jan
Original sleep study: (highlights)
sleep time of 172 minutes with an efficiency of 40.9%
REM not recorded
Sleep archictecture showed 12.8% stage 1, 82.2% stage 2, 0% for slow wave, 0% for REM
220 respiratory events total
20 Central Apneas
94 Obstructive Apneas
93 Hypopneas,
1 mixed apnea
12 respiratory effort related arousals.
rdi 77
AHI 73
Longest obstructive apnea 26 seconds
Min ox saturation 76%, mean oxygen saturation 92%
During sleep time, the SaO2 was below 90% for 20.8 minutes
19 spontaneous arousals
Think that is most of the important stuff
---------------------------------------------------------------------------------------------
Here are some highlights of titration (using two different masks) study which to this newbie layperson seem inconsistent with the above findings:
Total recorded time was 372 minutes.
EEG confrimed sleep time was 128 minutes with sleep efficiency of 36%
Sleep maintenance efficiency was 40%
REM Latency was 286 (???)
Sleep architecture showed 4.7% stage 1, 75.8% stage 2, 0% slow wave sleep and 19.5% REM sleep.
Wake after sleep onset time was 190 minutes.
Inspection of the tracing shows no apnea at any pressure (HELLO????), but thye technician had a difficult time titrating, and snoring ultimately led to a pressure of 17 cm. A pressure of 16 com clearly abolished apnea.
A pressure as low as 8 cm was probably adequate, but there were some desaturations.
Recommendation is to start patient of an auto-titrating CPAP with a low pressure of 8 cm an a high pressure of 17 cm with heated humidification. The CPAP device can be subsequently interrogated for further information.
------------------------------------------------------------
So, please correct me if I am misunderstanding but this seems to say that the titration study was pretty worthless yielding no usable results so we are going to use an auto titrating machine to figure this out??
And, give the huge number of apneas in the first sleep study, how is it that they couldnt find even one apnea in the titration study?
Thanks for any observations or further questions I should be asking. I meeting with an RT on Monday (yippeeee!!!)
Thanks much
Jan
Views: 12
Replies to This Discussion
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Permalink Reply by Jan on
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I like your explanation. I was caught up in the words that they were unable to titrate-- which i took to mean that they really couldn't perform the test properly. I also sorta didn't feel like the doctor communicated that this was a good result which probably fostered my curiosity about whether the test results were valid. But, communication with the doctor has been a bit on the difficult side so I probably can just chalk it up to that.
Thanks for your insights!
Jan
j n k said:Well, I'm no pro, but all that may not be quite as odd as it sounds at first. If you have a mask on, you have pressure, so your apnea may respond well to pressure, and a tech ain't gonna sit around all night waiting for an obstruction before starting to work on the snores.
A titration has many purposes. To me, the most important purpose is to see how you react to the pressure, which can unmask other problems. If no other problems are uncovered and it is proven you respond well to PAP treatment, you can't ask for much more than that, really. If they saw you with pressure, supine, in REM, without apneas, they earned their breakfast.
In my opinion, it would be nice if every patient could be checked out over several nights with an auto to see how things look over time, since anyone can have a particularly bad night, or particularly good night, on titration night. You scored with that recommendation, in my opinion, whatever triggered it.
So unless I'm missing something, I'm not really sure how things could have gone much better, all things said and done. The charts of the titration pressures would be needed to know much more.
But that's just my non-pro opinion as a fellow patient.
jeff
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Permalink Reply by D. W. Conn on
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The Diagnostic portion of your polysomnogram seems consistent with its interpretation. Now as we get into the Titration there were some difficulties true, however with that being said it was still within guidelines.
Some patients have difficulty with the titration night. The REM latency of 286 minutes is consistently seen during titration. Meaning that due to the titration and sleep fragmentation and maybe some anxiety REM was not achieved until later in the testing period. Increasing pressure due to snores is also necessary. Arousals can be generated from snores.
The 17cm seems a bit high but I have seen higher pressures.
The MD giving you an auto-titration unit is a great idea.
The MD/DO may have you repeat sleep study in 6 months or so…however in my case the auto-titration unit is optimal to meet my needs. Hope this helps you!
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Permalink Reply by RockRpsgt on
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Dinner jnk, the tech earned dinner. We eat breakfast before work.
j n k said:Well, I'm no pro, but all that may not be quite as odd as it sounds at first. If you have a mask on, you have pressure, so your apnea may respond well to pressure, and a tech ain't gonna sit around all night waiting for an obstruction before starting to work on the snores.
A titration has many purposes. To me, the most important purpose is to see how you react to the pressure, which can unmask other problems. If no other problems are uncovered and it is proven you respond well to PAP treatment, you can't ask for much more than that, really. If they saw you with pressure, supine, in REM, without apneas, they earned their breakfast.
In my opinion, it would be nice if every patient could be checked out over several nights with an auto to see how things look over time, since anyone can have a particularly bad night, or particularly good night, on titration night. You scored with that recommendation, in my opinion, whatever triggered it.
So unless I'm missing something, I'm not really sure how things could have gone much better, all things said and done. The charts of the titration pressures would be needed to know much more.
But that's just my non-pro opinion as a fellow patient.
jeff
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You wanna know what I LOVE about jnk??? Like my husband, he is so "simple minded". And that is meant in a VERY COMPLIMENTARY WAY. jnk and my husband seem to be able to see thru the morass and find that simple straight line to the point of the issue. A to B w/no detours or curves on the way.
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Rock, since you made no comments or additions, can I presume that based on the information I was able to provide that you and Jeff are in agreement on the interpretation? That would sure make my day :-) !!!
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Being on my phone makes it tough for go into detail. I agree with both conn and jnk. 6 months ago I would have said wtf. Now that I have a few similar totrations under my belt it is a tough call. We do not know what that tech saw or do we know what his policies are. With that said a trial by auto I believe was a good call.
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