LOCATION: Outpatient, Hospital
PATIENT: Terry Cain
PHYSICIAN: Gregory Dawson, MD
The patient had a previous diagnosis of obstructive sleep apnea.The four-stage study was started at 2200 hours and continued through 0600 hours the next day. This was done basically with CPAP (continuous positive airway pressure) titration. The patient had a total of 469.5 minutes in bed, 410 minutes asleep, a sleep latency of 3.5 minutes, and 153 arousals; had a heart rate of 89 while awake and 81 while asleep; and during the titration had 22 respiratory events. Because we have a previous diagnosis of obstructive sleep apnea, we are trying to find the adequate level of titration for him. The longest duration of any of these events was 32 seconds, the lowest O2 (oxygen) saturation was 87%, and the lowest heart rate was 74, showing some minor hypoxic and minor cardiac effects of these events. He had 91 myoclonic leg jerks, all associated with arousal. At home, the patient's CPAP is set at 9 cm (centimeter). This study showed that he requires much more pressure with the REM state than he does with the other stages of sleep. At 16 cm of pressure, it eliminated most all of the desaturations and respiratory events, but the patient complains at the higher pressure flows and does not like the airflow.
The previous study recommended an auto titrating device, and I think that would be quite valuable for this gentleman. I agree with that opinion.
IMPRESSION: This patient requires very low amounts of pressure, up to 16 cm during REM state. I would suggest an auto titration device or demand CPAP device be used on this particular patient to try and accommodate that particular variation in his needs.
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