Level 3 interpretation Tanya Level 3 Sleep Study Interpretation DSR Tanya Information from patient: please include Name:* Date of Birth* MM slash DD slash YYYY BMI:* ESS:* Sa02 (While Awake):* AHI* ODI:* Mean Sa02:* Study Type:*DiagnosticCPAPCPAP (Auto)Oral ApplianceOxygenOtherInsert BOTH Pressure (cmH20):* Insert Pressure (cmH20):*Please enter a number greater than or equal to 0.Other: Technical:*Technical quality was satisfactoryAHI has been over-estimated by the automated scoring algorithmAHI has been under-estimated by the automated scoring algorithmThe severity of nocturnal hypoxemia has been over-estimated by periods of inaccurate oximetry recordingMonitoring time was shortReported sleep time was shortAirflow recording was sub-optimalOximetry recording was sub-optimalRDI may be underestimated due to sub-threshold oxygen desaturationRDI may be underestimated because the test was done on oxygenThe severity of nocturnal hypoxemia has been overestimated due to periods of inaccurate oximetry recordingAirflow monitoring was limited (less then 4 hours)Oximetry recording was limited ((less then 4 hours)OtherOther: Findings:* Intermittent hypoxia associated with changes in airflow characteristic of obstructive sleep apnea Intermittent hypoxia associated with changes in airflow characteristic of central sleep apnea Episodes of sustained hypoxia independent of discrete respiratory events Brief, sporadic episodes of hypoxia that do NOT appear to be due to sleep apnea Episodes of intermittent airflow limitation suggestive of increased upper airway resistance Intermittent changes in airflow and/or heart rate suggestive of a non-pulmonary sleep disturbance such as periodic leg movements Apnea is more frequent in the supine position No evidence of sleep apnea No evidence of nocturnal hypoxia The frequency of respiratory events was within normal limits Respiratory events occurred predominantly in the supine position Respiratory events occurred exclusively in the supine position The impact of body position on respiratory events could not be assessed since the patient was supine for most of the study Other Other: Apnea Severity:NormalNo significant obstructive sleep apneaPossible upper airway resistance syndromeMild sleep-disordered breathingMild obstructive sleep apneaModerately severe obstructive sleep apneaSevere obstructive sleep apneaCentral sleep apnea with morphology suggestive of Cheyne-Stokes respirationCentral sleep apnea with morphology suggestive of opiate-induced apneaMixed obstructive and central sleep apneaSupine dependant obstructive sleep apneaPersistent sleep apnea despite treatmentModerately severe, supine dependent obstructive sleep apneaMild, supine dependent obstructive sleep apneaUnable to assess due to technical limitations outlined aboveOtherOther: Hypoxia Severity:NormalMild hypoxiaModerate hypoxiaSignificant hypoxiaSevere hypoxia with pattern suggestive of hypoventilationPersistent hypoxia on current therapyOtherOther: Recommendations:* These findings should be correlated with clinical assessment of the patient to determine further management Consider a trial of CPAP therapy Treatment options include: CPAP, an oral appliance or lifestyle modification (weight loss, avoidance of alcohol and sedatives, sleep in non-supine position) Alternatives to CPAP include oral appliance and lifestyle modification (weight loss, avoidance of alcohol and sedatives, sleep in non-supine position) Rule out secondary causes of central sleep apnea (cardiac disease, neurological disorder, narcotics) Treatment of central sleep apnea should be directed towards the underlying cause Polysomnography should be considered in further evaluation and management CPAP should not be initiated in an unmonitored setting if nocturnal hypoventilation is suspected. Hypoxia is more severe than expected from the AHI. Co-existing cardiopulmonary causes of hypoxia (eg lung disease) should be considered Reported level of sleepiness is severe. Consider a non-respiratory sleep disorder if secondary causes of sleepiness have been excluded eg sleep deprivation, medical and psychiatric conditions, side effects of medication Reported level of sleepiness is severe. Consider a non-respiratory sleep disorder if sleepiness persists after a trial of CPAP and secondary causes of sleepiness have been excluded eg sleep deprivation, medical and psychiatric conditions, side effects of medication Consider referral to a sleep centre if a non-respiratory sleep disorder suspected Non-cyclical heart rate variability was observed. If cardiac arrhythmia is suspected, electrocardiographic assessment should be considered Treatment is working as intended. Observe if no residual symptoms Observe expectantly if the patient does not have sleep-related symptoms Observe sleep apnea expectantly if the patient does not have sleep-related symptoms Observe these mild abnormalities expectantly if the patient does not have sleep-related symptoms Suggest referral to a sleep centre for further evaluation including polysomnography If nocturnal hypoxemia is not adequately explained by lung disease, consider further evaluation by overnight. Consider trial of CPAP for obstructive events; if the patient does have a trial of CPAP, suggest follow up nocturnal monitoring to confirm that apnea and/or hypoxemia have resolved If the patient has persistent sleep apnea and sleep-related symptoms, despite optimization of cardiac function, consider consultation with a sleep medicine specialist Incomplete evaluation due to technical limitations; recommend that the study be repeated for a more comprehensive assessment If the patient does have a trial of CPAP, suggest follow up nocturnal monitoring to confirm that episodes of sustained hypoxemia have resolved If the patient does have a trial of CPAP, suggest follow up nocturnal monitoring to confirm that apnea has resolved If the patient does have a trial of CPAP, suggest follow up nocturnal monitoring to confirm that apnea and hypoxemia have resolved If the patient has persistent sleep apnea and sleep-related symptoms despite optimization of cardiac function, consider consultation with a Sleep Medicine specialist If pulmonary function testing does not show evidence of significant lung disease, consider referral for polysomnography to rule out sleep-disordered breathing Note borderline awake hypoxemia; clinical correlation required Note borderline awake hypoxemia which may be related to co-existing lung disease and/or obesity hypoventilation Correlate these findings with CPAP download to assess mask leak and optimization of pressure settings Correlate these findings with BPAP download to assess mask leak and optimization of pressure settings Correlate these findings with BPAP download to assess mask leak, optimization of pressure settings and need for supplemental oxygen Other Other: Δ
