Reports & Test Results LaurenceHolbrook.com

TEST RESULTS AND REPORTS

December 17, 2004 Sleep Study Report - Sleep Services of America - Steven Craig Resnick (410) 544-5191

SLEEP STUDY - MSLT

STUDY NOTES

The study was performed following polysomnography the previous night. The patient did not have any caffeine the day of the study. The first nap commenced two hours after wake time ,and subsequent naps were spread in two hour intervals. A total of five naps. REM was only noted the third nap.

RESULTS

The patient did fall asleep on three out of five naps. Average sleep latency was approximately 10 minutes. On the initial first two naps, the patient took awhile to fall asleep but then sleep latency was very brief on the following three naps with one sleep onset REM.

INTERPRETATION

This patient does have sleep apnea and some excessive daytime sleepiness, possibly condominant narcolepsy or at least idiopathic hypersomnolence and clinical correlation is advised. This is not diagnostic for narcolepsy at this time.

December 16, 2004 Sleep Study Report - Sleep Services of America - Steven Craig Resnick (410) 544-5191

SLEEP STUDY - DIAGNOSTIC POLYSOMNOGRAM

NARRATIVE

The patient was fit with a Respironics small mask and CPAP therapy was titrated from the beginning of the night.

The total recording time was 371 minutes.
The EEG confirmed total sleep time was 310 minutes.
Sleep efficiency of 85%.
Sleep onset was 1 minute.
REM latency was 15 minutes .
44 total respiratory events.
7 central apneas.
20 obstructive apneas.
6 hypopneas.
11 mixed apneas.
Respiratory disturbance index per hour of total sleep was 8.5.
REM respiratory disturbance index was 1.8.
Oxygen hemoglobin desaturation down to a nadir of 87%.
Mean oxygen saturation was 92% during REM sleep.
Mean oxygen saturation was 92% during non-REM sleep.

ANALYSIS OF STUDY

The study revealed the patient's sleep apnea was improved with the CPAP machine. A CPAP level of 8 cm of water pressure resulted in resolution of prior respiratory events.

SLEEP DATA

Sleep distribution was normal. Sleep efficiency was normal at 85%. Sleep latency was shortened and the REM latency was shortened. Alpha delta sleep was not present. Alpha intrusion into non-REM sleep was also not presented.

CARDIAC RHYTHM

Cardiac rhythm is found to be normal.

RECOMMENDATIONS

1. Treatment of nasal obstruction or, allergic rhinitis may improve sleep-related breathing disorders.

2. Weight loss is clinically indicated--excessive weight may worsen sleep apnea and snoring.

3. Avoid alcohol /sedatives--CNS depressants may worsen sleep apnea and snoring.

4. Driving precautions--hypersomnolence may contribute to accidents while driving or operating heavy equipment.

5. Consider evaluation by a sleep specialist.

6. Nasal CPAP therapy at 8 cm H20.

7. Consider MSLT (Multiple Sleep Latency Test) to document hypersomnolence and evaluate for narcolepsy/idiopathic hypersomnolence.

June 23, 2004 Sleep Study Report - Sleep Services of America - Steven Craig Resnick (410) 544-5191

TITRATION STUDY

The patient was fit with a Respironics mask, and C-PAP therapy was titrated from the beginning of the night.

The total recording time was 360 minutes
The EEG-confirmed total sleep time was 212 minutes
Sleep efficiency of 60.7%
Sleep onset was 8 minutes
REM latency was 244 minutes
18 total respiratory events
0 central apneas
0 obstructive apneas
18 hypopneas
0 mixed apneas
Respiratory disturbance index per hour of total sleep time 5.1
REM respiratory disturbance index was 7.5
Oxygen hemoglobin desaturations down to a nadir of 83%
Mean oxygen saturation was 90% during REM sleep
Mean oxygen saturation was 92% during non-REM sleep
The patient stated his quality of sleep was better than usual.

DIAGNOSIS

The study revealed the patient's prior sleep apnea was significantly improved with the C-PAP machine. A C-PAP level of 10 cmH20 resulted in resolution of the prior respiratory events.

SLEEP DATA

Sleep distribution was found to be abnormal, with diminished REM sleep. Sleep efficiency was reduced at 61%. Sleep latency was shortened and REM latency was prolonged. Alpha-delta sleep was not present. Alpha intrusion into non-REM sleep was also not present.

RECOMMENDATIONS

Treatment of nasal obstruction or allergic rhinitis may improve sleep-related breathing disorders.
Weight loss if clinically indicated, as excessive weight may worsen sleep apnea and snoring.
Avoid alcohol/sedatives, as CNS depressants may worsen sleep apnea and snoring.
Driving precautions should be instituted, as hyper somnolence may contribute to accidents while driving or operating heavy equipment.
Nasal C-PAP therapy at 10 cmH20 should be tried.
If the patient is intolerant of C-PAP or C-PAP is not clinically effective, consider sleep specialist evaluation.

May 25, 2004 Sleep Study Report - Sleep Services of America - Steven Craig Resnick (410) 544-5191

SPLIT NIGHT STUDY

Total recording time 148 minutes
Total EEG confirmed sleep time 110 minutes
Sleep efficiency 83%
Sleep onset 20 minutes
REM latency __ minutes
76 Total respiratory events
1 central apneas
10 obstructive apneas
61 hypopneas
4 mixed apneas
Respiratory distrubance index per hour of sleep time 41.5
REM respiratory disturbance index ___
Oxygen hemoglobin desaturations down to a nadir of 86%
Mean oxygen desaturation was 86% during REM
Mean oxygen desaturation was ___ during non-REM
Moderate periodic limb movements were noted

The patient was fit with a comfort media mask and CPAP therapy was titrated from the beginning of the night.

Total recording time 229 minutes
Total EEG confirmed sleep time 157 minutes
Sleep efficiency 71%
Sleep onset 53 minutes
REM latency 79 minutes
18 Total respiratory events
4 central apneas
7 obstructive apneas
5 hypopneas
2 mixed apneas
Respiratory distrubance index per hour of sleep time 6.9
REM respiratory disturbance index 33
Oxygen hemoglobin desaturations down to a nadir of 86%
Mean oxygen desaturation was 89% during REM
Mean oxygen desaturation was 89% during non-REM

ANALYSIS OF THE STUDY

The study revealed the patient did have severe obstructive sleep apnea. The patient's periodic limb movements were mostly related to snore related events and decreased with the use of the CPAP machine. Hypopneas were the main respiratory events which occurred predominantly during non-REM sleep. Arousals were frequently noted with the respiratory events and oxygen desaturations were mild. The prior sleep apnea was partially improved with CPAP machine. A CPAP level of 7 cm water pressure resulted in partial resolution of prior respiratory events.

SLEEP DATA

Sleep distribution was abnormal. _______ total sleep and diminished REM sleep. Sleep efficiency was reduced at 83%. Sleep latency was prolonged. REM latency was normal. Alpha delta sleep is not present. Alpha intrusion into non-REM sleep is also not present.

RECOMMENDATIONS

Treatment of nasal obstruction or allergic rhinitis may improve sleep-related breathing disorders.
Weight loss is clinically indicated--excessive weight may worsen sleep apnea and snoring.
Avoid alcohol/sedatives--CNS depressants may worsen sleep apnea and snoring.
Driving precautions--hypersomnolence may contribute to accidents while driving or operating heavy equipment.
Nasal CPAP therapy at 9 cm H2O.
If the patient is intolerant of CPAP, or CPAP is not clinically effective, consider sleep specialist evaluation.

March 22, 2004 Cardiologist report - Dr. David B. Aiello - (410) 768-6600

About October, 1996 I had a RIMA and LIMA CABG (Left & Right Internal Mammary Coronary Artery Bypass Graft)

Quit smoking
Doc is not sure of the etiology of my intermittent symptons
Grafts are patent, continue to treat medically
Treated to maintain LDL of less than 100
Use sublingual NTG (Nitroglycerine pills), if they don't work go to hospital
Call Doc if I have any symptoms at Gymn (while exercising)
Suspects a lot of symptons are related to smoking and underlying lung disease (???)

September 9, 2003 - UMMC Discharge Instructions

Also, I still dunno what happened - I couldn't find any notes on my visit to the hospital in September - I was cleaning some files on my PC and I found scanned copies of the discharge papers they had given me - I can't imagine why I scanned them unless I gave the originals to my Doc - but he said he didn't have them - at any rate the cardiologist did say to have a follow up with Doc and the Cardiologist with 2 weeks - and he did add an aspirin to my daily meds - On 9/8, my Glucose was (H)137 mg/dl and on 9/9 it was 92 mg/dl (instantaneous readings)

May 5, 2003 Sleep study report - Sleep Services of America - Steven Craig Resnick (410) 544-5191

TITRATION STUDY

CPAP therapy was titrated from the beginning of the night.

Total recording time 370 minutes
Total EEG confirmed sleep time 284 minutes
Sleep efficiency 79%
Sleep onset 9 minutes
REM latency 70 minutes
30 Total respiratory events
10 central apneas
1 obstructive apneas
19 hypopneas
0 mixed apneas
Respiratory distrubance index per hour of sleep time 6.3
REM respiratory disturbance index 17.6
Oxygen hemoglobin desaturations down to a nadir of 86%
Mean oxygen desaturation was 93% during REM
Mean oxygen desaturation was 92% during non-REM

ANALYSIS OF THE STUDY

The study revealed the patient's prior sleep apnea was significantly improved with the CPAP machine. A CPAP level of 12 cm of H2O resulted in resolution of prior respiratory events as well as the snoring.

SLEEP DATA

The sleep distribution was found to be abnormal with diminished REM sleep. Sleep efficiency was slightly reduced at 79%. Sleep latency was shortened. The REM latency was normal. Alpha delta sleep was not present.

RECOMMENDATIONS

Treatment of nasal obstructions or allergic rhinitis
Weight loss is clinically indicated - excessive weight may worsen sleep apnea and snoring.
Avoid alcohol/sedatives - CNS depressants may worsen sleep apnea and snoring.
Driving precautions - hyper somnolence may contribute to accidents while driving or operating heavy equipment.
Thyroid function tests - hypothyroidism may worsen sleep apnea
Nasal CPAP therapy at 12 cm of H2O
If the patient is intolerant of CPAP or CPAP is not clinically effective, consider Evaluation by a sleep specialist
Clinical correlation is advised

March 19, 2003 Sleep study report - Sleep Services of America - Steven Craig Resnick (410) 544-5191

ALL NIGHT SLEEP STUDY

Total recording time 403 minutes
Total EEG confirmed sleep time 250 minutes
Sleep efficiency 66%
Sleep onset 6.5 minutes
REM latency 126 minutes
183 Total respiratory events
0 central apneas
67 obstructive apneas
97 hypopneas
19 mixed apneas
Respiratory distrubance index per hour of sleep time 43.8
REM respiratory disturbance index 86
Oxygen hemoglobin desaturations down to a nadir of 68%
Mean oxygen desaturation was 86% during REM
Mean oxygen desaturation was 90% during non-REM

DIAGNOSES

The study revealed the patient had severe obstructive sleep apnea. Apneas and hypopneas were the main respiratory events, which occurred predominantly during both non-REM as well as REM sleep. Arousals were frequently noted with the respiratory events. The oxygen desaturations were found to be moderate.

SLEEP DATA

Sleep distribution was found to be abnormal, with diminished REM sleep. Sleep efficiency was reduced at 66%. Sleep latency was shortened. REM latency was normal. Alpha-delta sleep was not present. Aplha intrusion into non-REM sleep was also not present.

RECOMMENDATIONS

Consider C-PAP trial to determine efficacy of this device in treating this patient's sleep-related breathing disorder and determine correct pressure home use.
Treatment of nasal obstructions or allergic rhinitis may improve sleep related breathing disorders.
Weight loss if clinically indicated, as excessive weight may worsen sleep apnea and snoring.
Avoid alcohol/sedatives, as CNS depressants may worsen sleep apnea and snoring.
Driving precautions should be instituted, as hyper somnolence may contribute to accidents while driving or operating heavy equipment.
Consider Evaluation by a sleep specialist
All recommendations require clinical correlation. The severity of obstructive sleep apnea and the indication for treatment is a function of both the apnea/hypopnea index (RDI) and the clinical features including the degree of excessive daytime sleepiness.