Mount .Sinai Doctors Fax Faculty Practice• -1°: CA°C.1Thi Phone: Far i/46 39) -OVVp Pages: • leef4- Fro4rlidtizi anif Annette Pitt' Denary, OftLcil Care and Sleep Medicine Phone: (212)241-5656 Fax: (212) 241.8866 O Urged O For ce-vievir ?least comme3t ❑Pizzasc It...ply O putszecycle Notes The document accompanying this transmission contains inforrr.ation confidential or privileged. that may be This information is intended for the use cf the or entity name individual above only and use by any other party is not a utho rized.The authorized recipient of this information is prohibted from disclosing this Information to any other party except as permitted or required by applicable federal, state, local laws, and regulations and must use and r-al ntain the Information in accordance with all applicable laws and regulations. If copying, you are distribution, not the intended:recipient, you are hereby notiFed that any disclosure, or use of the contents of these document is strictly prohibited. If you have received this information in error, please notify immediately by phone. the sender • °colt Sqn1.17Z11Z HSIV tud10:80 1710Z/10/80 EFTA00601566 Sinai Mount Mount Sinai School of Medicine Comprehensive Center for Sleep Medicine 1176 Fifth Avenue, 61° Floor New York, NY 10029-6574 ( (212)241-5098 Fax: (212)241-4828 Polysomnogram Report kftptill qtstr brirn Name: EPSTEIN, JEFFREY Date of 01/20/1953 ‘y6 - 3C°- 02f6 Birth: MR N°: 7206913 Study Date: 07/29/2014 Age: 61 y Gender: Male Height 6' 0" Weight: 190 lbs. BMI: 25.8 INDICATIONS: Prior home sleep study showing obstructive sleep apnea MEDICATIONS: sodium chloride (SALINE NASAL) 0.65 % aerosol,spray fluticasone (FLONASE) 50 mcg/actuation spray.suspension omega-3 acid ethyl esters (LOVAZA) 1 gram capsule ezetimibe (ZETIA) 10 mg tablet co010, ubiquinol, 100 mg capsule fenofibrate (TRICOR) 145 mg tablet rosuvastatin (CRESTOR) 10 mg tablet PROCEDURE This Nocturnal Polysomnography (NPSG) consisted of the continuous monitoring of electroencephalogram (EEG), electro-oculogram (EOG), electromyogram (EMG) from the submental muscles and the anterior tibias of both legs, electrocardiogram (EKG), nasal-oral airflow, thoracic and abdominal respiratory effort, pulse oximetry, and body position. SLEEP ARCHITECTURE The patient spent 355 minutes in bed with a normal sleep latency of 10 minutes. Total sleep time (TST) was 292 minutes, with a slightly reduced sleep efficiency of 82%. REM latency was normal at 167 minutes. Wake time after sleep onset (WASO) was 53 minutes. There were a total of 20 electrocortical arousals, resulting in an arousal index of 4.1 per hour. Overall sleep architecture was mildly abnormal with reduced REM and slow wave sleep. Patient reported sleep quality was same compared to usual. Minutes % TST NREM 259 88.7% N1 23 7.7% N2 235 80.3% N3 2 0.7% R 33 11.3% WASO 53 MOVEMENT ANALYSIS A total of 0 periodic limb movements of sleep (PLMS) were noted (0 PLMS with arousals), resulting in a PLMS index of 0.0/hour (PLMSArl 0.0/hr). 170/70 a2Erl BROI 9988117ZZI2 HSPI tudl0:80 140Z/10/80 EFTA00601567 RESPIRATORY ANALYSIS During wakefulness the respiratory rate was 4 breaths per minute and the mean oxygen saturation was 95%. Overall there were a total of 0 apneas and 31 hypopneas resulting in an apnea/hypopnea index (AHI) of 6.4 events per hour. The supine AHI was 7.1 events per hour, and the non-supine AHI was 0.0 events per hour. Oxygen Desaturation Index (Number of 4% desaturations per hour) = <1/hour. Moderate snoring. NREM R ALL stages AHI Obstructive Apnea 7.0/hr 0 1.8/hr 0 6.4 0/hr Hypopnea(*) 30 1 31 Mixed Apnea 0 0 0 Central Apnea 0 0 0 RDI Mean event time (A+H) 7.0/hr 30 sec 1.8/hr 35 sec 316.4/hr sec / Lowest oxygen saturation % % 90% (*) Hypopnea is defined as a reduction in nasal pressure waveform amplitude by >50% for 10 seconds or more with either a drop in oxygen saturation >3% or an EEG arousal associated with the event. CARDIAC ANALYSIS normal sinus rhythm was dominant throughout the night, with an average heart rate of 57.3 (± 7.8) beats per minute. IMPRESSION Snoring with minimal sleep disordered breathing. RECOMMENDATIONS Clinical correlation required. Treatment may or may not be indicated based on patient's symptoms and other clinical problems. Note that if patient has been using CPAP routinely up to this night, a single night off CPAP may underestimate obstructive sleep apnea somewhat. Treatment options for sleep disordered breathing may include nasal CPAP or Bilevel PAP, ENT evaluation for possible upper airway surgery, or an oral appliance. Weight loss in an overweight patient is often helpful. Patients with sleep disordered breathing should be advised to avoid alcohol or sedating medications. A graphic summary follows. a-ta 74 94—L. hns) Steven H. Feinsilver, MD Director, Center for Sleep Medicine Professor of Medicine, Icahn School of Medicine at Mount Sinai Diplomate, American Board of Internal Medicine, Pulmonary Disease, and Sleep Medicine trupti aerl ARAH AARR[VZZLZ HSH wd7.0:20 VI.07/7.0/20 EFTA00601568 04/04 Page t699 2122418866 DISH 03:02pm 08/02/2014 m62 acco cow 0010 WIZ coo IN HE I D0T0061 xwam [amoM I' ea.000AH OS 06 0 [Tines} Ouch/ 05 06 4 *4.574441 trA it" t ri e esi l W/ t 04441Thi #4$ -/4 01"1"44"1 iAlAtH k MI R7 f as th r" -7-'11-111I T1 ' Tz00 COIO ONO CCU a0 C0 N641 Nab ; :4 lad rs, AWININI1S HdThD EFTA00601569