DATE OF STUDY: MM/DD/YYYY
INDICATION: Evaluation of sleep-disordered breathing.
STUDY TYPE: Diagnostic polysomnogram.
SLEEP ARCHITECTURE: There was reduced sleep efficiency at 55% and increased REM latency at 289 minutes. Severely fragmented sleep with light snoring was noted, and all stages of sleep were recorded during the course of the study.
RESPIRATORY EVENTS: A review of the record showed 0 central apnea, 0 obstructive apnea, 3 mixed apneas, 0 hypopnea, and 87 respiratory-event related arousals, yielding a non-REM respiratory disturbance index of 21.7, a REM respiratory disturbance index of 21.4, averaging to a respiratory disturbance index of 21.6 and an apnea-hypopnea index of 0.7, consistent with upper airway resistance syndrome.
OTHER FINDINGS: EKG recorded during the course of the study was normal sinus rhythm in the 60-80 beats per minute range with no ectopy noted. Oximetry recorded during the course of the study was 95% to 97% without significant desaturation. Periodic limb movements: There were 32 limb movements recorded, yielding a mildly elevated limb movement index of 7.7. The patient did not meet criteria of a split-night protocol.
IMPRESSION/RECOMMENDATION: Upper airway resistance syndrome. Respiratory disturbance index of 21.6/apnea-hypopnea index of 0.7. There was coexisting mild periodic limb movement disorder. Given the mild nature of disease noted, treatment options would include avoidance of the supine position and oral appliance therapy. On the presence of coexistent excessive daytime sleepiness, a full-night continuous positive airway pressure titration study in the lab could potentially be considered.
Sleep Education SOAP Note/Polysomnogram Sample #2
INDICATION: Further evaluation of sleep-disordered breathing.
STUDY TYPE: CPAP titration with original study performed on (XX), yielding a mild obstructive sleep apnea, RDI of 12.6/AHI of 4.4 with coexistent mild periodic limb movement disorder.
SLEEP ARCHITECTURE: There was reduced sleep efficiency at 80% and normal REM latency at 112 minutes. Improved sleep quality from previous was noted. Snoring was eradicated with CPAP application. Stages I, II, and REM were recorded during the course of the study.
RESPIRATORY EVENTS: A review of the record showed 0 central apnea, 0 obstructive apnea, 0 mixed apnea, 1 hypopnea, and 1 respiratory-event related arousal, yielding a non-REM respiratory disturbance index of 0 and a REM respiratory disturbance index of 2.9, averaging to a respiratory disturbance index of 0.4, and an apnea-hypopnea index of 0.2. All within normal range.
OTHER FINDINGS: EKG recorded during the course of the study was normal sinus rhythm in the 70-90 beats per minute range with occasional PVCs. Oximetry recorded during the course of the study was 93% to 94% with a nadir to 89% associated with primary respiratory events. Periodic limb movements: There were 31 limb movements recorded, yielding a mildly elevated limb movement index of 6.4. CPAP was initiated at lights out at 10:21 p.m. at 6 cm of water pressure and titrated in response to the primary respiratory events, snoring, and arousals. CPAP was titrated incrementally to a maximum of 9 cm of water pressure. The patient initially struggled with CPAP but settled during the course of the study. Events were controlled. REM was achieved. Snoring was eradicated. Fair tolerance was noted.
IMPRESSION/RECOMMENDATION: Previously diagnosed mild obstructive sleep apnea, respiratory disturbance index 12.6/apnea-hypopnea index 4.4 with mild periodic limb movement disorder with fair response to continuous positive airway pressure at 9 cm of water pressure with a small EasyLife nasal mask. It is suggested that therapy be initiated at the above level with followup for clinical efficacy.
Sleep Education SOAP Note/Polysomnogram Sample #3
DATE OF STUDY: MM/DD/YYYY
INDICATION: Evaluation of sleep-disordered breathing.
STUDY TYPE: Diagnostic polysomnogram.
SLEEP ARCHITECTURE: There was reduced sleep efficiency at 85.6% and increased REM latency at 197 minutes. Mildly fragmented sleep with mild intermittent snoring was noted, and all stages of sleep were recorded during the course of the study.
RESPIRATORY EVENTS: A review of the record showed 0 central apnea, 7 obstructive apneas, 1 mixed apnea, 2 hypopnea, and 47 respiratory-event related arousals, yielding a non-REM respiratory disturbance index of 12.9, a REM respiratory disturbance index of nonapplicable, averaging to a respiratory disturbance index of 10.3, and apnea-hypopnea index of 1.8 consistent with mild obstructive sleep apnea.
OTHER FINDINGS: EKG recorded during the course of the study was normal sinus rhythm in the 60-70 beats per minute range. No ectopy was noted. Oximetry recorded during the course of the study was 95% to 96% with a nadir to 82% associated with primary respiratory events. Periodic limb movements: There were no significant limb movements recorded during the course of the study. The patient did not meet criteria for split night protocol.
IMPRESSION/RECOMMENDATION: Mild obstructive sleep apnea, respiratory disturbance index of 10.3/apnea-hypopnea index of 1.8. Given the mild nature of the disease noted, treatment options would include avoidance of the supine position, oral appliance therapy, or in the presence of coexistent excessive daytime sleepiness, a full-night continuous positive airway pressure titration study in the lab could be considered.
Sleep Education SOAP Note/Polysomnogram Sample #4
DATE OF STUDY: MM/DD/YYYY
INDICATION: Evaluation of sleep-disordered breathing.
STUDY TYPE: Split-night polysomnogram.
SLEEP ARCHITECTURE: There was reduced sleep efficiency at 80.6% and increased REM latency at 181 minutes. Severely fragmented sleep with light snoring was noted and all stages of sleep were recorded during the course of the study.
RESPIRATORY EVENTS: A review of the record showed 3 central apneas, 90 obstructive apneas, 2 mixed apneas, 0 hypopnea, and 12 respiratory event-related arousals, yielding a non-REM respiratory disturbance index of 62.6, a REM respiratory disturbance index is not applicable, averaging to a respiratory disturbance index of 62.6 and an apnea-hypopnea index of 55.6 consistent with severe obstructive sleep apnea.
OTHER FINDINGS: EKG recorded during the course of the study was sinus rhythm in the 50-70 beats per minute range with episodic PVCs. Oximetry recorded during the course of the study was 94%-95% with a nadir to 87% associated with primary respiratory events. Periodic limb movements: There were no significant limb movements recorded during the course of the study. Due to the severity of sleep-disordered breathing, split-night protocol was initiated and CPAP was started at 12:28 a.m. at 4 cm of water pressure and titrated in response to primary respiratory event, snoring and arousal. CPAP was titrated incrementally to a maximum of 6 cm of water pressure. Events were controlled, REM was achieved, and good tolerance was noted.
IMPRESSION/RECOMMENDATIONS: Severe obstructive sleep apnea, respiratory disturbance index of 62.6/apnea-hypopnea index of 55.6 with a good response to continuous positive airway pressure at 6 cm of water pressure with a small Respironics EasyLife nasal mask. It is suggested that therapy be initiated at the above level with followup for clinical efficacy.
