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UARS and polysomnogram please help

Hi there!  I got the results of my polysomnogram and the diagnosis stated "normal sleep study."  There was nothing to indicate apnea - I had a 76.3% sleep efficiency over 344 min, with 67 min sleep latency, 216 Stage R latency, WASO 39 min, and my sleep stage percentages seemed okay at N1 9.9%, N2 56.7%, N3 17.9% and R 15.6%.  

AHI was 5.2.  It says I had 29 hypopneas and 1 central apnea (18 in NREM and 12 REM), no real difference between sleep positions (just slightly higher supine), 4% index was 0.3, baseline SaO2 98% and min 93%.  The report said no snoring or evidence of OSA.

The weird thing is the sleep fragmentation.  I had an arousal index of 32.3/hour of sleep, which to me seems extremely high.  PLM arousal index was 0.  I'm confused as to why the arousal index is so high if the arousals were not caused by respiratory events or limb movements.  

I have excessive daytime sleepiness for five years that is unrelenting.  At first my doctor said I had insomnia, but now she wants me to have a split night study.  I will have to pay for this out of pocket and can't afford to put out that kind of money if it's not going to tell us any more than it already has.  Could another breathing disorder such as UARS be causing the high arousal index?  Can that be detected by polysomnogram, and wouldn't they have been looking for that on the first study?  
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Avatar universal
MEDICAL PROFESSIONAL
I agree with CarrerLady. This is the problem with UARS. It's how it's diagnosed on a formal sleep study. An apnea or hypopnea is any stoppage in breathing that's 10 seconds or longer, but if you stop breathing and wake up anywhere from 1-9 seconds, then it's not counted as an apnea or hypopnea. You have the expected high arousal index. Some of these will be RERAs (respiratory event related arousals) and others will be labeled as non-respiratory related. My feeling is that many of these non-RERAs are in fact, respiratory related. Inside your throat you have pressure sensors that can detect when you're about to obstruct. It sends a signal to your brainstem and then an automatic feedback signal is sent to the deep brain sleep centers to tell it wake up to reverse the relaxation that occurs in deep sleep, which causes an arousal, without the signals even reaching your outer brain (which is what the EEG leads tell you).

Interestingly, your AHI of 5.2 gives you the diagnosis of obstructive sleep apnea, as long as you have daytime fatigue (using Medicare's criteria). You should qualify for a trial of CPAP, which I do recommend, even though in general, most people with UARS can't tolerate. But there are some that do benefit. Your best bet is to find a dentist that specializes in dental devices for OSA and UARS. By pulling your lower jaw forward, you pull your tongue forward, opening up your airway. Jaw surgery is an option if you have very small jaws, and soft tissue surgery to shrink your tongue is an option, but one of very last resort. Take a look at my article on UARS.
Helpful - 1
Avatar universal
I agree with you, this is not a "normal" sleep situation. Both your excessive daytime sleepiness and your arousal index over 30 suggest that they are missing something in the lab. Either their instruments are not set to measure it, or they are not looking for it. In my study, they called it "respiratory effort-related arousals" (RERAs) They could measure it, but when they were supposed to try to treat my symptoms, they focused on my 1 apnea, and ignored my 148 RERAs.

I don't think a split night study will help, either. You need to find someone who knows the difference between obstructive sleep apnea and UARS. I had to see three doctors. And since UARS doesn't respond as well to CPAP (the only treatment any of my doctors seems to authorize) I am not out of the woods yet.

Good luck.
Helpful - 0
Avatar universal
Thank you!  The article describes me to a t.  I can't afford the split-night study my doctor wants me to have because of my insurance deductible, but would I benefit at all from just seeing an ENT specialist? Or is it really important that I try the CPAP?
Helpful - 0

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