[sleep center name omitted]
[street address omitted]
STERLING HEIGHTS, MICHIGAN [zip code omitted]
PHONE: [omitted] FAX: [omitted]
PATIENT NAME: VILLANUEVA, MANUEL REFERRING DOCTOR: [omitted]
DOB: 8/[omitted]/66 DATE OF STUDY: 1/11/07
NOCTURNAL POLYSOMNOGRAPHY STUDY
CLINICAL HISTORY: Manuel Villanueva is a 40-year-old male, height 5 ft 5 in, weight 181 lbs. He underwent a prior polysomnography study that revealed severe obstructive sleep apnea with an apnea/hypopnea index of 47, sinus bradycardia, and slight decrease in sleep efficiency. He sleeps from 11:00pm to 6:00am and does not perform shift work. A sleep study is being performed for nasal CPAP titration.
PROCEDURE: Polysomnography was conducted on the above night. The following were monitored: central and occipital electroencephalogram, electro-oculogram, submentalis electromyelogram, nasal and oral airflow, thoracic and/or abdominal wall motion, anterior right and left tibialis electromyogram and electrocardiogram. Arterial oxygen saturation was monitored using a pulse oximeter.
EEG AND SLEEP STAGE ANALYSIS: Manuel slept for 286 minutes out of a total time spent in bed of 361 minutes for sleep efficiency of 79%. He spent 265 minutes in non-REM sleep and 21 minutes in REM sleep and a normal sleep onset of 2 ˝ minutes. He was awake for 72 minutes after the sleep study began with a slightly prolonged latency to persistent sleep. There were 17 arousals noted throughout the recording, giving the arousal index of 3.6. An analysis of his individual sleep stages showed that he spent an increased amount of stage 1 sleep of 25% of the night. Stage 2 sleep was seen in 53.8% of the night and there was a decreased amount of stage 3-4 slow wave seen in 13.8% of the night. REM sleep also was decreased and soon in only 7.5% of the night. His latency of stage 1, 2, and persistent sleep was normal, but he did have a prolonged REM latency of 144 minutes.
RESPIRATORY PARAMETER ANALYSIS: There were three apneas for an apnea index of
0.6 and two hypopneas for a hypopnea index of 0.4, giving a total of five
respiratory events and a total apnea/hypopnea index of 1. All of the respiratory
events occurred in the supine position with his lowest oxygen desaturation
reaching 94%. An analysis of his respiratory events revealed one obstructive
apnea and two obstructive apneas seen in the supine position in REM sleep. His
longest apnea was 44 seconds.
…continued
EKG ANALYSIS: His normal steady heart rate during sleep was 64 with no PVCs or PACs noted. There were 52 epochs of sinus bradycardia and no sinus tachycardia was noted.
EMG ANALYSIS: There were no abnormal leg movements that led to any arousals.
NASAL CPAP TITRATION: Nasal CPAP was initially started at 5 cm of water pressure and sequentially increased to 6 and then 7 cm of water pressure. At 7 cm, there was improved sleep with an apnea/hypopnea index of 0.6. Nasal CPAP was tolerated fairly well and he did not use a heated humidifier. No additional equipment was needed.
IMPRESSION: Obstructive sleep apnea treated with nasal CPAP with an optimal CPAP pressure setting at 7 cm of water pressure. He tolerated CPAP well and apparently does not need any equipment.
FINAL DIAGNOSIS: Obstructive sleep apnea treated with nasal CPAP at 7 cm of water pressure.
[name omitted], D.O.
Medical Director
D: 1/11/07
T: 1/29/07
JRW:mef