Sleep Study Results: Navigating OSA and CSA Challenges

Sleep study

Hello Doctor, I underwent a PSG (with ENT) and while the validity was over 90%, the hospital's bed was too hard and the sound insulation was poor.
I clearly remember that I only slept about 2 to 3 hours (I rarely experience insomnia).
I spent most of the first half of the night with my eyes closed, listening to others snore, and I almost wanted to give up and go home.
The report indicated a sleep duration of 6 hours, with an AHI of about 10 events/hour, but in reality, I only slept for a little over 2 hours, with all the apneas occurring within that time frame.
Would such results be accurate? (If calculated based on 2 hours, the AHI would be close to 30 events/hour).
The results showed that I have OSA, CSA, and mixed apnea (even the ENT doctor thought the test results seemed odd), which is a bit confusing, as CSA was more prevalent than OSA.
I would like to ask the doctor: CSA had a maximum duration of 64 seconds, OSA had a maximum of 84.5 seconds, my blood oxygen dropped to 75%, and there were 22 arousals/hour concentrated in the 2 hours of REM sleep.
Due to my fatigue, dizziness, excessive daytime sleepiness, and poor memory, my daily life and work are severely affected.
According to the AHI numbers, it is classified as mild, and I was only prescribed some medication to reduce nasal congestion and observe further (is it necessary to confirm step by step during the diagnosis and treatment process?).
I feel like I have no way out.

1.
Can I request a retest at the hospital, or do I need to go to another hospital? Will health insurance cover it?
2.
Even if the AHI numbers are underestimated, if the symptoms are similar to severe cases, is there no treatment available?
3.
I have heard that the causes of CSA are very complex and often triggered by severe diseases, but aside from the symptoms, I am basically healthy.
I was unaware of my apneas and have consulted cardiology, endocrinology, blood sugar, liver function, and EEG in the past six months, all of which were normal.
Which specialty should I consult next?
4.
There were 11 OSA events and 33 hypoventilation events during those 2 hours.
Even if CSA cannot be treated, shouldn't the OSA and hypoventilation components also be treated?
5.
Personally, during "exhalation," I feel immediately blocked and unable to exhale with any effort during the day, needing to open my mouth.
At night, I wake up multiple times due to being unable to exhale because of the blockage.
I also feel that my tongue is large, have bite marks on my tongue, and my speech seems to be affected.
However, I feel that I cannot communicate this clearly with the doctor, which makes me very desperate.

SS, 40~49 year old female. Ask Date: 2015/02/16

Dr. Chen Bozhang reply Family Medicine

1.
Can I request a retest at the hospital, or do I need to go to a different hospital? Will health insurance cover it? Most people find it uncomfortable to undergo a sleep study due to changes in their sleep environment, and some may be skeptical about the results.
However, this test remains one of the more objective assessments available today, as it provides numerous parameters for reference.
For this reason, unless your sleep duration is insufficient for a proper evaluation, a retest is generally not recommended.
If you do wish to retest, you may opt for a home sleep apnea test, which would be out-of-pocket, and it could also address concerns about a hard mattress and soundproofing issues.
2.
Even if the AHI (Apnea-Hypopnea Index) is underestimated, if the symptoms are severe, is treatment not possible? Sleep studies can serve as an objective reference but are not absolute.
There are also questionnaires that can provide subjective references.
Not all patients require a sleep study before treatment; many believe that this approach is more objective.
However, it is important to note that treatment is based on your symptoms rather than solely on numerical values.
3.
I have heard that the causes of Central Sleep Apnea (CSA) are complex and often triggered by serious illnesses.
However, aside from my symptoms, my body is generally normal.
Previously, I was unaware of my breathing cessation, and due to fatigue, I have consulted with specialists regarding my heart, thyroid, blood sugar, liver function, and EEG, all of which were reported as normal.
Which specialty should I consult for further evaluation? I suggest you obtain copies of your reports and seek a second opinion from another sleep specialist.
4.
During the 2-hour observation, I had 11 events of Obstructive Sleep Apnea (OSA) and 33 events of hypoventilation.
Even if CSA cannot be treated, shouldn't the OSA and hypoventilation components also be addressed? Anyone with sleep apnea should receive treatment, as untreated sleep apnea increases the risk of cardiovascular diseases.
5.
Personally, I feel a blockage when I exert effort during exhalation, even during the day, and I must open my mouth to breathe.
At night, I wake up multiple times gasping for air due to the blockage.
I also feel that my tongue is large, with bite marks, and my speech seems affected.
However, I find it difficult to communicate these issues clearly with my doctor, which is quite frustrating.
Typically, sleep apnea occurs only during sleep; if you do not experience discomfort while awake, I would recommend seeing an Ear, Nose, and Throat (ENT) specialist for an endoscopic examination.

<Chen Po-Chang and assisted by Dr.
Chiu Po-Han from the ENT department.>>

Reply Date: 2015/02/16

More Info

Understanding the complexities of sleep studies, particularly regarding Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA), can be quite challenging. Your experience highlights several critical points that need to be addressed.

Firstly, regarding the accuracy of your sleep study results, it is essential to understand that polysomnography (PSG) is considered the gold standard for diagnosing sleep disorders. However, the quality of the data collected can be significantly affected by the environment in which the study is conducted. If you were only able to sleep for 2-3 hours due to discomfort from the bed and noise, this could lead to an underestimation of your apnea-hypopnea index (AHI). The AHI is calculated based on the total sleep time, and if your actual sleep time was significantly less than reported, it could indeed skew the results. In your case, if the AHI were calculated based on just 2 hours of sleep, it would suggest a more severe condition than indicated by the report.

1. Re-testing: You can certainly request a re-evaluation of your sleep study, especially if you feel that the initial results do not accurately reflect your condition. It may be beneficial to consider a home sleep apnea test (HSAT) if you find hospital settings uncomfortable. While HSATs are typically less comprehensive than PSG, they can still provide valuable insights into your sleep patterns. Insurance coverage for repeat testing can vary, so it’s best to check with your provider.

2. Treatment despite AHI: Even if your AHI suggests mild OSA, your symptoms are significant and warrant treatment. The severity of symptoms does not always correlate with AHI numbers. Many clinicians will treat based on clinical presentation rather than solely on AHI. If you are experiencing excessive daytime sleepiness, fatigue, and cognitive issues, these are valid reasons to pursue treatment options, which may include CPAP therapy, lifestyle modifications, or other interventions.

3. Further evaluations: Given that CSA can be complex and often associated with other medical conditions, it may be prudent to consult a neurologist or a sleep specialist who can further evaluate your symptoms and the potential underlying causes. Since you have already ruled out several conditions, a comprehensive review of your sleep study alongside a physical examination may provide additional insights.

4. Treatment for OSA and hypoventilation: Yes, both OSA and hypoventilation should be addressed, especially since untreated sleep apnea can lead to serious health complications, including cardiovascular issues. Treatment options may include CPAP therapy, oral appliances, or surgical interventions, depending on the severity and specific characteristics of your apnea.

5. Communication with your doctor: It’s crucial to communicate your symptoms clearly with your healthcare provider. If you feel that your concerns are not being adequately addressed, consider seeking a second opinion. Your description of feeling obstructed during exhalation and experiencing significant daytime symptoms suggests that there may be anatomical or functional issues contributing to your sleep apnea. A thorough evaluation by an ENT specialist may be warranted to assess for any anatomical abnormalities, such as enlarged tonsils or a deviated septum, that could be contributing to your symptoms.

In conclusion, navigating the complexities of sleep disorders like OSA and CSA requires a comprehensive approach that considers both subjective symptoms and objective data from sleep studies. It’s important to advocate for your health by seeking further evaluations and treatments that align with your experiences and concerns. Your symptoms are valid, and addressing them is crucial for improving your quality of life.

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