This article demonstrates the obstructive sleep apnea (OSA) study through polysomnography (PSG) of a 40-years old Bangladeshi male patient who had been suffering from OSA and relevant complications for a long time. PSG study revealed severe OSA of the subject and thus suggested usage of nasal continuous positive airway pressure (CPAP) during sleep. Titration study of a CPAP machine of the patient set the air pressure at 11.5 cm H2O.
Keywords:
CPAP, hypopnea, polysomnography, respiratory disturbance index, REM sleep.
(Review Completed)
Sleep apnea is a physiological complication that occurs during sleep [1-7]. It disturbs the sleep and breathing processes of the person affected [1-7]. It is of two kinds: obstructive sleep apnea (OSA) and central sleep apnea (CSA) [1-7]. Most of the patients suffering from sleep apnea are of OSA types [1-7]. OSA occurs due to repetitive pauses in breathing originated from the collapse of the upper airways [1-7]. It blocks the normal supply of oxygen to the blood resulting in hypoxia, weakness and disturbance in metabolic and other activities [1-7]. Sleep disturbance causes excessive daytime sleepiness (EDS), weakness, irritability, attention deficiency and other psychological problems [1-7]. Globally, 3-7% of adult males and 2-5% of adult females suffer from sleep apnea [1-7]. It has been posing threat to global productivity and safety also, as the people suffering from sleep apnea cannot exert their full efforts and merit to their services and sleepiness cause accidents at domestic, industrial, traffic and aviation sectors. Such a physiological nuisance must not go untreated [8]. Thus, tests to determine the presence of sleep apnea and to provide remedy against it is inevitable [9-11]. Considering these facts, current study has been aimed at determining the presence of sleep apnea followed by its management strategy adaptation to the subject in concern.
Polysmonography (PSG) study
Study performred: Nocturnal polysomnography.
History: Snoring, excessive day time sleepiness (EDS), apneas, hypertension (HTN).
Procedure: Complete PSG with a digital sleep system using the international 10-20 electrode placement for recording electroencephalogram (EEG), electrooculography (EOG), electromyography (EMG) from chin, electrocardiography (ECG), respiratory effort, a noninvasive method for monitoring blood oxygen saturation (oximetry) and peripheral oxygen saturation (SpO2), body position, airflow, snoring sound, pulse rate and limb movement channels.
Summary: Total recording time was 627.5 minutes, with a total sleep time of 442.45 minutes and a sleep efficiency of 70.5% [Figure 1-6]. The patient’s sleep latency was 35.0 [Figure 1-6]. There was a total of 15.6% rapid eye movement (REM) sleep with the REM latency of 37.0 minutes [Figure 1-6]. There was 8.9% of stage 1 sleep, 46.7% stage 2, 25.8% stage 3 and 3.1% stage 4 sleep [Figure 1-6].
Respiratory events: Respiratory analysis demonstrated 164 obstructive sleep apneas (OSA) and 0 mixed sleep apneas (MSA) with a total of 164 apneas and an apnea index (AI) of 22.2 [Figure 2-3]. There was 72 hypopneas (airflow reduction), with a respiratory disturbance index (RDI) of 32.0 [Figure 2-3]. The patient spent 48.0% of total sleep time in the supine position, with a supine RDI of 28.6, versus a non-supine RDI of 32.0. The REM RDI was 50.4, versus non-REM RDI of 28.6 [Figure 2-3].
Oxygen saturation: The lowest desaturation was 76%, with 50.4 minutes of desaturations between 81% and 90% [Figure 2-3].
Arousal index: The total arousal index was at 31.6 [Figure 4]. Repiratory arousal index was 31.6.
Periodic leg movement: Periodic leg movements (PLM) were noted, with a PLM index of 2.0 and PLM index with arousals of 0.0 [Figure 5].
Diagnosis:
- Severe obstructive sleep apnea and hypopnea syndrome (OSAHS).
- Severe desaturation.
Recommendation
Immediate nasal continuous positive airway pressure (CPAP) titration.
CPAP titration study set up
Study performed: Nocturnal polysomnography (PSG) with CPAP titration.
Procedure: as described previous.
CPAP titration: CPAP titration was performed with a nasal CPAP. CPAP pressure had been raised from 3-11.5 cmH2O pressure. Patient could tolerate that pressure comfortably. The snoring and apneas had been disappeared. Total recording time was 621.8 minutes, with a total sleep time of 426.0 minutes and a sleep efficiency of 68.5% [Figure 7-12]. The patient’s sleep latency was 28.5 [Figure 7-12]. There was a total of 12.1% REM sleep with the REM latency of 170.0 minutes [Figure 7-12]. There was 3.9% of stage 1 sleep, 63.1% stage 2, 16.5% stage 3 and 4.3% stage 4 sleep [Figure 7-12].
Respiratory analysis: Respiratory analysis demonstrated 0 obstructive apneas and 0 mixed apneas with a total of 0 apneas and an apnea index of 0.0 [Figure 8-10]. There was 0 hypopneas, with a respiratory disturbance index (RDI) of 0.0 [Figure 8-10]. The patient spent 20.0% of total sleep time in the supine position, with a supine RDI of 0.0, versus a non-supine RDI of 0.0. The REM RDI was 0.0, versus non-REM RDI of 0.0 [Figure 8-10]. The lowest desaturation was 90%, with 0.0 minutes of desaturation between 81% and 90% [Figure 8-10].
Respiratory arousal index: Respiratory arousal index had been increased at 38.0. Total arousal index had been raised at 38.0 [Figure 8-10].
Periodic leg movement (PLM): PLM was noted, with a PLM index of 1.0 and PLM index with arousals of 0.0. The total arousal index was increased at 38.0 [Figure 11].
- Usage of nasal CPAP at 11.5 cm H2O during sleep regularly.
- Maintain ideal body weight.
Sleep apnea is a global health crisis. Its management strategies including usage of CPAP during sleep, maintenance of ideal body weight and lifestyle modification should be encouraged. Care should be taken of the sleep apnea patients at both home and work places. Health care professional, scientists, policy makers should formulate strategies to combat this physiological and psychological burden of the global populace.
The author gratefully thank Professor Dr. Sarder A. Baki for providing the polysomnography and CPAP titration data and Japan-Bangladesh friendship hospital for providing the sleep lab facilities.
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