Instant Diagnostic Systems, Inc. Independent Diagnostic Testing Facility - NPI: 1922017516 1740 4th Ave. SE, Suite A, Decatur, AL 35601 PO Box 2449, Decatur, AL 35602 Phone: 800-355-0691 Fax: 888-771-5159 Page 1 of 4 Home Sleep Study - Summary & Interpretation Patient: Demo Demo 123 Street Decatur, AL 35603 Male, DOB: 12/25/1955 BMI 38.5 Ordering Physician: Preferred Medical Equipment Supplier: N/A Demo Demo Fax: 555-555-5555 NPI: 1234567890 IDS Test # 857191 Quick Summary: Patient self-administered a Home Sleep Study with Resmed Apnealink Plus Type 3 device while on Room Air on 2010-03-07. An AHI of 20 was scored during evaluation period of 06:51:39. Medicare guidelines (NCD 240.4) state that AHI of 20 will meet coverage criteria for Positive Airway Pressure in combination with treating physician's clinical correlation. Sleep Specialist Interpretation of Home Sleep Study Impressions: TE ST • The diagnosis of at least moderate sleep apnea is supported based on the reported Apnea-Hypopnea Index (AHI*) • Oxygen saturation was < 90% for more than 5 minutes, minimum oxygen saturation was below 90, and mean oxygen saturation was below listed norms, which suggests hypoxemia. • Sleep apnea may have contributed to the oximetry findings. In addition, oxygen saturation can be affected by numerous conditions including, but not limited to restrictive or obstructive pulmonary disease, neuromuscular disorders, and recorded artifact. E Recommendations: PL • Consider Sleep Apnea treatment as appropriate for this patient. M • Treatment options may include: Positive Airway Pressure (PAP) devices such as continuous PAP (CPAP), auto-adjusting PAP (APAP), and bi-level PAP (Bi-PAP). Oral appliance implementation during sleep and upper airway surgery may be considered in selected patients as deemed suitable by the appropriate specialist. • If APAP is utilized for titration and/or treatment, an initial range setting of 5-20 cm H2O may be considered if there are no contraindications. SA • If CPAP is utilized without APAP titration an in-laboratory facility based titration is recommended. • With any PAP device, monitor patient compliance via downloadable reports if available. *Medicare has specific compliance requirements during the first 90 days of use. See pg 4 for details • Weight loss and smoking cessation are behavioral interventions which may supplement a primary treatment for sleep apnea. Improvement in sleep apnea may be assessed following successful completion of the aforementioned. • Alcohol and sedative use may worsen sleep apnea and daytime sleepiness. Patient counseling is recommended as appropriate. • Where applicable, utilize PAP device efficacy reports, additional testing, and face to face clinical evaluation subsequent to any treatment, changes in treatment, or major behavioral modifications. • If symptom resolution is not achieved, or suspicion of continued sleep disturbance persists, consider referral to a sleep specialist. • As long as patient exhibits symptoms of daytime sleepiness or drowsiness, caution against operating a motor vehicle, or engaging in other activities which may be hazardous in the presence of diminished alertness • Recommend further evaluation of suggested hypoxemia via nocturnal pulse-oximetry. • If indicated, supplemental oxygen may be considered in conjunction with selected Apnea treatment. (Refer to an appropriate specialist as needed.) Signed on 3/12/2010 4:33:00 PM by Dr. EDWARD TURPIN, ABSM; NPI: 1225118847 NOTE: Please see page 4 for important footnotes, clinical reference, and more detail about home sleep studies and the Apnealink device and software. Instant Diagnostic Systems, Inc. Independent Diagnostic Testing Facility - NPI: 1922017516 1740 4th Ave. SE, Suite A, Decatur, AL 35601 Mailing Addr: PO Box 2449, Decatur, AL 35602 Phone: 800-355-0691 Fax: 888-771-5159 Page 2 of 4 Home Sleep Study - Analysis Patient: IDS Report #: 857191 Evaluation Start/Stop Time: 22:10 ST Apnealink+ Mfg by Resmed Germany; Records Airflow, Respiratory Effort, Pulse Rate, O2 Saturation: Recording Started: - 5:1 Total Valid Evaluation Time*: 06:51:39 Analysis: Serial #: 223190000485 2010-03-07 at 22:00:00 Recording Duration: 07:03:40 Spo2* 06:53:09 ) TE Analyzed Automatically (Total Eval Times - Air-Flow* 06:51:39 * Total Airflow Eval Time is the denominator used in calculation of AHI and other event indices above, while Spo2 Eval Time is used for Pulse-Oximetry indices below. Indices/Averages Normal Range Totals: AHI* (Apnea Hypopnea Index) 20 < 5/hr Snoring Events 3558 All Apneas Index < 5/hr Total Apneas 62 - Obstructive Apneas 56 - Central Apneas 1 - Mixed Apneas 0 - Unclassified Apneas 5 Total Hypopneas 75 Breaths 4523 - Central Apnea Index 0 - Mixed Apnea Index 0 11 SA Hypopnea Index M - Unclassified Apnea Index 1 Avg Breath per min. PL - Obstructive Apnea Index 8 E 9 < 5/hr - 10.99 % Flow Ltd Br. w/o Snore 9 < Approx 60 Total Flow Ltd. Br w/o Snoring 422 % Flow Ltd. Br. w. Snore < Approx 40 Total Flow Ltd Br w/ Snoring 544 12 Proportion of probable Cheyne Stokes epochs: 0% --Normal: 0% Pulse Oximetry O2 Desaturation Index 19 < 5/hr Avg. Saturation 93 Lowest Desat Event Total Desaturations 132 94% - 98% Spo2 <= 90% 51 Min. 12% 63 - Spo2 <= 89% 34 Min. 8% Lowest Saturation 63 90% - 96% Spo2 <= 88% 29 Min. 7% Baseline Spo2 97 - Spo2 <= 85% 22 Min. 5% Avg Pulse Rate (bpm) 63 - Spo2 <= 80% 12 Min. 3% Max Pulse Rate (bpm) 101 60 - 90 Min Pulse Rate (bpm) 40 50 - 70 Invalid Spo2 During Airflow Evaluation: 0.1% Auto Analysis Default Parameters: Apnea [20%; 10s; 80s; 1.0s; 20%; 60%; 8%]; Hypopnea [50%; 10s; 100s; 1.0s]; Snoring [6.0%; 0.3s; 3.5s; 0.5s]; Desaturation [4.0%]; CSR [0.50] Analyzer Ver. - 3.01 Ahts DL L - 2.3.1.0 Collector Ver. - 2.01 Lin DL L - 142 IDS Sleep Ver. - 3.09.10.26 Firmware- 05.0200000 Flt DL L- 145 Rs DL L - 113 Oxi DL L - 58 Oximetry Successful? True Device Code- 0000000C Instant Diagnostic Systems, Inc. Independent Diagnostic Testing Facility - NPI: 1922017516 1740 4th Ave. SE, Suite A, Decatur, AL 35601 Mailing Addr: PO Box 2449, Decatur, AL 35602 Phone: 800-355-0691 Fax: 888-771-5159 Patient: SA M PL E TE ST IDS Report #: Page 3 of 4 857191