[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: 11/21/06
NOCTURNAL POLYSOMNOGRAPHY STUDY
CLINICAL HISTORY: Manuel Villanueva is a 40-year-old male, height 5 ft 5 in, weight 181 lbs. He reportedly sleeps anywhere from midnight to 3AM and awakens a 8AM to 12PM. He does perform shift work. He does have complaints of daytime sleepiness along with loud snoring observed periods of apnea. He has history of chronic sinusitis and reports being sleepy throughout the day. He is now undergoing polysomnography study to rule out obstructive sleep apnea.
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: The patient slept for 311 minutes out of a total time spent in bed of 361 minutes for a slight decreased sleep efficiency of 86%. He spent 275 minutes in non-REM sleep and 36 minutes in REM sleep, and had a normal sleep onset of 2 minutes. He was awake after sleep study began for 48 minutes. His latency to persistent sleep was normal. There were a total of 243 arousals seen throughout the recording given an elevated arousal index of 45.9. Analysis of his individual sleep stages revealed that he spent 29.1% of the night in stage 1 sleep (marked increase), 57.7% of the night in stage 2 sleep, 1.8% of the night was spent in stage 3-4 slow wave sleep (markedly decreased), and 11.4% of the night was spent in REM sleep. His latency to stage 1 and 2 sleep was shortened and he did have a prolonged latency to stage 3-4 slow wave sleep and normal REM latency of 95 minutes.
RESPIRATORY PARAMETER ANALYSIS: There were a total of 179 apneas for an index of 34.5 and 64 hypopneas for an index of 12.3 giving a total of 243 respiratory events and an apnea/hypopnea index of 46.8. All of his respiratory events occurred in the non-supine position with his lowest oxygen desaturation reaching 93%. All of his respiratory events were seen when slept on his right side. Analysis of his respiratory events revealed that there were 108 obstructive apneas, and 58 obstructive hypopneas all seen in the non-supine position during non-REM sleep. In REM sleep, there were 11 obstructive apneas and 6 obstructive hypopneas seen in the non-supine position with his longest apnea in non-REM being 70 seconds and in REM sleep it was 72 seconds.
EKG ANALYSIS: Normal steady heart rate during sleep was 65 with no PACs or PVCs noted. There were 62 epochs of sinus bradycardia, and no sinus tachycardia was seen.
EMG ANALYSIS: There were no abnormal leg movements noted throughout the recording that led to any arousals.
A 4-nap Multiple Sleep Latency Test was nor performed due to the severity of the obstructive sleep apnea.
IMPRESSION: At this time, there is evidence for severe obstructive sleep apnea noted with an apnea/hypopnea index of 46.8 without significant oxygen desaturation and seen exclusively when he slept on his right side. There were some epochs of sinus brady but no other significant cardiac arrhythmias were noted. There is no evidence for periodic limb movement disorder of sleep. Daytime hypersomia was not measured. There was a slight decrease in sleep efficiency with frequent arousals and disruption in sleep architecture noted.
FINAL DIAGNOSIS:
1. Severe obstructive sleep apnea with an apnea/hypopnea index of 46.8 without
oxygen desaturation.
2. No evidence for periodic limb movement disorder of sleep.
3. Some epochs of sinus bradycardia but no other significant cardiac arrhythmias
were noted
4. Daytime hypersomia was not assessed.
5. Slight decrease in sleep efficiency with disruption in sleep architecture and
frequent arousals were noted secondary to #1 above.
TREATMENT RECOMMENDATIONS: 1) Weight loss. 2) Nasal CPAP titration. 3) Avoid driving if daytime sleepiness is present.
Please correlate with your clinical impressions:
[name omitted], D.O.
Medical Director
D: 11/30/06
T: 11/30/06
JRW:bjp