Ramblings of a sleep apnea e-patient

You just got finished with your sleep study, also known as a polysomnogram or a PSG. As a patient, you have a right to receive a copy of that report in the United States. But what’s on the report you get may not be the same report your sleep doctor (Somnologist) gives your Primary Care Physician (PCP). You may get a one or two page report that doesn’t include a lot of data. You want the seven to ten page report with the extra data.

Ask for a full report with condensed graphs and all doctor’s notes.

If they tell you you can’t have a “full” report and that it would be a thousand pages long, tell them thank you and that’s why you are requesting the typical table reports and condensed graphs. That means all the high-rate and medium-rate data for the duration of the full sleep study are condensed into graphs that are the width of a single page. Your study could have been four hours or eight hours. Regardless, it’s made to fit the page width. If you can press them further, ask them for a CD of data from the PSG. That way, if you ever have any questions about the actual data they observed, you’ll be able to ask for a second opinion from another sleep doctor using the actual data they collected. It’s unlikely they’ll give you a copy of the infrared video data, but if it’s frame compressed enough to fit it all on a single DVD with the polysomnography, they might. You won’t be able to read any of the data on the CD or DVD because it will be in a format only their specialized PSG software can read, but another lab will be able to read it.

If you’ve ever had a brain MRI, you can often ask for a CD or DVD that will allow you to view the brain scan right on your own computer. It’s the modern equivalent of an X-ray print. At some point, it might be nice if sleep labs would include a reader on a CD or DVD that would allow you to view the data for that particular PSG, just like a modern MRI. We’re not there yet.

Not all sleep labs use the same software, but they are similar enough that you should see the same kinds of things showing up from lab to lab in a typical report sent to your PCP.

These are things to expect in a report:

  • Declaration of Procedure: A sentence or two explaining what scientific methods were adopted for your study – about a paragraph of information.
  • Data Summary: When your sleep study started and ended, total duration, sleep efficiency, REM latency, Sleep architecture run-down, number of eeg arousals, etc. This will be one or two paragraphs.
  • Body position: Time spent in each position during the night, maybe a sentence or two.
  • Titration Results: A sentence or two of discovery, a chart titration numbers, statements about EKG and PLMS
  • Impressions: General observations, maybe a few sentences
  • Recommendations: Maybe a few sentences.
  • Polysomnography Report:
    • A selection of tables with lots of numbers including…
      • Sleep architecture
      • Sleep stages distribution.
      • Respiratory analysis
      • Respiratory analysis by body position
      • Sleep stage duration and positional analysis
      • PLMs analysis by stage
      • PLMs with and without arousals
      • snore analysis
      • spontaneous arousals
      • O2 Saturation Table and results
      • Titration results – a condensed table
    • A selection of condensed graphs including…
      • Hypnogram – the stages of your sleep by hour – a simple line graph that condenses many of your EEG readings into a simple-to-interpret graph about your sleep stages.
      • Arousal – a tick mark for every arousal on a graph by hour — another set of EEG readings simplified.
      • Respiratory – a tick mark for every central and obstructive apneas/hypopnea/desat by hour
      • Snoring – a tick mark for every snore by hour
      • SpO2 – oxygen saturation graph by hour
      • CPAP/BiPAP pressure in cm H20 by hour
      • O2 in liters/minute (if you were using canned oxygen) by hour
      • Sleep position – supine, prone, left side, right side, by hour
      • PLMs – leg movement tick mark for right, left, both legs and with arousal, by hour
  • Cardiac Report:
    • A summary table with lots of numbers about data collected from your pulse during various states.
    • A condensed graph of pulse rate by hour
    • A summary table of cardiac events
    • A condensed graph with tick marks for each cardiac event discovered by hour

As an extra part or perhaps as a separate study, you may also have had a Multiple Sleep Latency Test (MSLT).

This may include:

  • Sleep Architecture: table with analysis for 4 or 5 naps
  • Hypnogram: condensed line graph of sleep stages by hour
  • Data Summary: a paragraph explaning what was done
  • Impression: A sentence or two about the results
  • Recommendations: Maybe a few sentences

In general, this will be much shorter, since the consideration is more about ease of sleep onset than it is about titration — about one or two pages.

Below is an example PSG scanned in and made available for you to see what you might expect. This one includes the MSLT done after the regular titration. Everything that is blurred out is personal information. The below pages should show up in a lightbox gallery on top of this page if your browser has javascript enabled.

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