Table 1.
Serial polysomnograms demonstrating OSA improvement with weight loss and T&A.
| PSG Number 1 | PSG Number 2 | PSG Number 3 | |
|---|---|---|---|
| Time from stroke presentation, d | 29 | 325 | 962 |
| Type of study | Split-night PSG | Split-night PSG | Split-night PSG |
| Interim interventions | N/A | Weight loss | T&A |
| Weight (lbs) | 367 | 300 | 291 |
| BMI (kg/m2) | 62.1 | 48.4 | 48.4 |
| BMI percentile, z score | 99.74, 2.80 | 99.51, 2.59 | 99.29, 2.45 |
| Key PSG parameters | |||
| TST (min) for baseline portion | 132 | 182 | 213 |
| % stage N1/N2/N3 sleep | 2.9/43.4/33.1 | 7.6/68.8/10.0 | 3.7/63.0/17.1 |
| % REM sleep | 20.7 | 13.6 | 16.1 |
| Sleep efficiency | 91.9% | 86.9% | 88.4% |
| % supine | 63.3 | 0 | 5.9 |
| Total AHI | 175 | 40 | 5.6 |
| REM sleep AHI | 120 | 83 | 20 |
| Supine AHI | 170 | NA | 24 |
| % obstructive/mixed/central | 98.2/1.8/0.0 | 100/0/0 | 100/0/0 |
| Arousal index | 51.5 | 20.4 | 11.8 |
| Oxyhemoglobin nadir | 60% | 74% | 90% |
| % time SpO2 < 90% | 58.4% | 2.8% | 0% |
| % etCO2 > 50 mm Hg | 0% | 0% | 0% |
| PAP parameters | |||
| Best bilevel PAP pressure | 19/12 | 14/10 | 10/5 |
| AHI at best PAP pressure | 1 | 0.4 | 2.0 |
| Oxygen nadir | 73% | 94% | 93% |
| Arousal index | 11.7 | 5.6 | 2.0 |
| % tcPCO2 > 50 mm Hg | 0% | 0% | 0% |
Of note for PSG number 1, while the patient was on optimum bilevel PAP, AHI was not normalized in the supine position; however, AHI was normalized in the lateral recumbent position. As such, the patient was recommended for positional therapy in addition to bilevel PAP until the following studies. AHI = apnea-hypopnea index, BMI = body-mass index, etCO2 = end-tidal carbon dioxide, OSA = obstructive sleep apnea, PAP = positive airway pressure, PSG = polysomnography, REM = rapid eye movement, SpO2 = oxyhemoglobin saturation, T&A = adenotonsillectomy, tcPCO2 = transcutaneous monitoring of carbon dioxide partial pressure, TST = total sleep time.