Sample Report Polysomnography Study
Clinical History: The patient is a 50-year-old female who presents with a chief complaint of, "I have trouble falling asleep and staying asleep. Once I wake up at night, I have trouble going back to sleep. I often wake up with a headache." She measures 5 feet 8 inches tall, weighs 191 pounds, and has a neck circumference of 13-1/2 inches. The Epworth sleepiness scale score is 6.
Review of Sleep Questionnaire: Review shows that she goes to bed around 10 to 10:30 p.m., varying about 1 to 2 times a week. It takes her about an hour to go to sleep. Often, at the onset of sleep, she feels muscular tension, has an uncontrollable urge to move the legs, has some form of discomfort, has vivid dream-like scenes, and feels anxious. She sleeps for about 5 to 6 hours, awakening 2 to 3 times with some difficulty going back to sleep. At times, she may be awake 2 to 3 hours, usually in the second half of the night. Often during sleep, she feels afraid of not returning to sleep if she awakens, has a bed partner, is restless, gets up for one reason or another, and has dreams. Her sleep is often disrupted by the need to urinate and feeling like she has to move the legs. She wakes up at 6 a.m., getting out of bed at 6:05 a.m. Often she depends on the alarm clock. She often has a hard time waking up, wakes up with a headache, wakes up with a dry mouth, or within 1 to 2 hours of appointed time of awakening. She takes 5 naps a week, lasting for 1 hour, which she finds refreshing. She often is sleepy during the day, but rarely falls asleep unintentionally. She often feels muscular tension. She never feels weak when suddenly excited.
The family history is significant for a nephew who has trouble sleeping and staying asleep, and a son who has trouble falling asleep. Behaviorally, she does not drink alcoholic beverages, smoke cigarettes, or use recreational drugs. She drinks decaffeinated coffee, 1 or 2 caffeinated tea preparations a week, and 20 ounces of soda in a typical day. She has a history of headaches, depression, low blood pressure, back trouble, and allergies. She has not had any oronasal surgeries, but has had a thyroid surgery.
Review of Bed Partner Questionnaire: Suggests that the patient is observed every night to have loud snoring and twitching and jerking of the legs and arms. The patient is not described as being sleepy during the day.
Medications: Synthroid, Paxil, ginkgo biloba, magnesium, Surfak, and vitamin complex preparations.
Report: The study was requested as a split protocol, but the patient did not satisfy criteria and only a diagnostic study is available. The patient slept for 5-1/2 hours with a sleep efficiency of 73.4%. There were increased arousals of 17 events per hour and awakenings of 1 event per hour. The sleep architecture was disrupted with reduced slow-wave sleep of 2.4% and relatively stable REM stage of 20%. There was no reduction in sleep latencies. The apnea/hypopnea index was 5.6, which in the supine position was 16.9 and during REM stage was 14.6. The patient had 6 apneic episodes and 25 hypopneic episodes. The former were mainly obstructive. The patient had soft to loud and occasionally disruptive snoring. The mean oxygenation was 93.5% SaO2 with 36 desaturations, the lowest of which was 88% SaO2. The patient spent 0.1% of the study in oxygenation of less than 89% SaO2. The mean heart rate was 63.1 beats per minute, with a minimum of 47 and maximum of 94. The periodic leg movement index was 0. No dramatic EEG changes were seen.
Impression: Sleep apnea syndrome, mainly obstructive, mild overall, with desaturation as low as SaO2 of 88%. This was exaggerated during the supine position and during rapid eye movement sleep stage. No increased periodic leg movements of sleep, with the possible historical suggestion of restless leg syndrome based on the patient's sleep questionnaire.
Recommendations: In general, for mild sleep apnea, conservative measures such as weight loss, appropriate sleep hygiene, avoidance of the supine position, avoidance of sedative hypnotics including alcoholic beverages at night and smoking, if applicable, are recommended. In addition, alternative approaches may also include oronasal appliances and surgical procedures. There may be a basis for using nasal CPAP in this patient's case, but a stepwise approach is suggested.
The patient has no increased periodic leg movements of sleep but may have a strong suggestion of restless leg syndrome based on the sleep questionnaire. Before treatment is to be given, however, this should be further explored in the patient's subsequent visits to determine if it is a true sleep disrupter. Restless leg syndrome may occur independently or may be associated with other comorbid states, including iron-deficiency anemia, peripheral neuropathy, uremia, vitamin deficiencies, and the like.
As mentioned previously, the study was requested as a split protocol, but the patient did not meet criteria and only a diagnostic study is available.
It is not clear whether this study alone explains the patient's chief complaint of sleep initiation and maintenance insomnia. She alludes occasionally to psychological symptoms and, as such, psychophysiologic mechanisms and psychological etiologies may need to be explored. Systemic conditions may also need to be explored.
The patient should be advised regarding safety in driving while in a somnolent condition. Clinical correlation is suggested.
Review of Sleep Questionnaire: Review shows that she goes to bed around 10 to 10:30 p.m., varying about 1 to 2 times a week. It takes her about an hour to go to sleep. Often, at the onset of sleep, she feels muscular tension, has an uncontrollable urge to move the legs, has some form of discomfort, has vivid dream-like scenes, and feels anxious. She sleeps for about 5 to 6 hours, awakening 2 to 3 times with some difficulty going back to sleep. At times, she may be awake 2 to 3 hours, usually in the second half of the night. Often during sleep, she feels afraid of not returning to sleep if she awakens, has a bed partner, is restless, gets up for one reason or another, and has dreams. Her sleep is often disrupted by the need to urinate and feeling like she has to move the legs. She wakes up at 6 a.m., getting out of bed at 6:05 a.m. Often she depends on the alarm clock. She often has a hard time waking up, wakes up with a headache, wakes up with a dry mouth, or within 1 to 2 hours of appointed time of awakening. She takes 5 naps a week, lasting for 1 hour, which she finds refreshing. She often is sleepy during the day, but rarely falls asleep unintentionally. She often feels muscular tension. She never feels weak when suddenly excited.
The family history is significant for a nephew who has trouble sleeping and staying asleep, and a son who has trouble falling asleep. Behaviorally, she does not drink alcoholic beverages, smoke cigarettes, or use recreational drugs. She drinks decaffeinated coffee, 1 or 2 caffeinated tea preparations a week, and 20 ounces of soda in a typical day. She has a history of headaches, depression, low blood pressure, back trouble, and allergies. She has not had any oronasal surgeries, but has had a thyroid surgery.
Review of Bed Partner Questionnaire: Suggests that the patient is observed every night to have loud snoring and twitching and jerking of the legs and arms. The patient is not described as being sleepy during the day.
Medications: Synthroid, Paxil, ginkgo biloba, magnesium, Surfak, and vitamin complex preparations.
Report: The study was requested as a split protocol, but the patient did not satisfy criteria and only a diagnostic study is available. The patient slept for 5-1/2 hours with a sleep efficiency of 73.4%. There were increased arousals of 17 events per hour and awakenings of 1 event per hour. The sleep architecture was disrupted with reduced slow-wave sleep of 2.4% and relatively stable REM stage of 20%. There was no reduction in sleep latencies. The apnea/hypopnea index was 5.6, which in the supine position was 16.9 and during REM stage was 14.6. The patient had 6 apneic episodes and 25 hypopneic episodes. The former were mainly obstructive. The patient had soft to loud and occasionally disruptive snoring. The mean oxygenation was 93.5% SaO2 with 36 desaturations, the lowest of which was 88% SaO2. The patient spent 0.1% of the study in oxygenation of less than 89% SaO2. The mean heart rate was 63.1 beats per minute, with a minimum of 47 and maximum of 94. The periodic leg movement index was 0. No dramatic EEG changes were seen.
Impression: Sleep apnea syndrome, mainly obstructive, mild overall, with desaturation as low as SaO2 of 88%. This was exaggerated during the supine position and during rapid eye movement sleep stage. No increased periodic leg movements of sleep, with the possible historical suggestion of restless leg syndrome based on the patient's sleep questionnaire.
Recommendations: In general, for mild sleep apnea, conservative measures such as weight loss, appropriate sleep hygiene, avoidance of the supine position, avoidance of sedative hypnotics including alcoholic beverages at night and smoking, if applicable, are recommended. In addition, alternative approaches may also include oronasal appliances and surgical procedures. There may be a basis for using nasal CPAP in this patient's case, but a stepwise approach is suggested.
The patient has no increased periodic leg movements of sleep but may have a strong suggestion of restless leg syndrome based on the sleep questionnaire. Before treatment is to be given, however, this should be further explored in the patient's subsequent visits to determine if it is a true sleep disrupter. Restless leg syndrome may occur independently or may be associated with other comorbid states, including iron-deficiency anemia, peripheral neuropathy, uremia, vitamin deficiencies, and the like.
As mentioned previously, the study was requested as a split protocol, but the patient did not meet criteria and only a diagnostic study is available.
It is not clear whether this study alone explains the patient's chief complaint of sleep initiation and maintenance insomnia. She alludes occasionally to psychological symptoms and, as such, psychophysiologic mechanisms and psychological etiologies may need to be explored. Systemic conditions may also need to be explored.
The patient should be advised regarding safety in driving while in a somnolent condition. Clinical correlation is suggested.
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