Polysomnography Interpretation Report (PAP Titration PSG)

Patient: [Name] — MRN: [MRN] — DOB: [DOB] — Sex: [Sex]

Date of Study: [Study date] ([Start time] to [End time])

Study Type: Attended PAP Titration PSG — [full-night / split-night]

Referring Clinician: [Referring clinician]

Interpreting Clinician: [Interpreting clinician]

Indication and Clinical Context

[Brief indication for PAP titration, anchored to prior diagnostic testing when available: prior study date, AHI, severity classification. Note prior PAP experience (naïve / established user) and known intolerance issues if documented. Include pertinent comorbidities (CHF, COPD, neuromuscular disease, opioid use, suspected hypoventilation) only when documented. If prior diagnostic results are unavailable, state this explicitly.]

Study Description

Acquisition and Scoring: Attended in-lab polysomnography with PAP titration was performed using a standard montage. Hypopneas scored using [≥3% desaturation and/or arousal / ≥4% desaturation criterion]. (If dual indices are reported, state that both AHI-3%/arousal and AHI-4% were calculated.)

PAP Setup: [Interface type: nasal pillows / nasal / oronasal / full face], size [size]. Chin strap [used / not used]. Heated humidification [on / off]. (If multiple interfaces were trialed, list chronologically with reason for change.)

Titration Protocol: [Starting mode and pressure]. [Pressure increment approach and criteria for escalation]. (Note any deviations from standard protocol.)

Sleep Architecture

• Total Recording Time: [hh:mm]
• Total Sleep Time: [hh:mm]
• Sleep Efficiency: [%]
• Sleep Latency: [min]
• REM Latency: [min]
• WASO: [min]
• Sleep Stages: N1: [%], N2: [%], N3: [%], REM: [%]
• Total Arousal Index: [events/hour]

(Add brief comment only if architecture findings are clinically significant.)

PAP Titration Course

(Provide chronological account of titration steps sufficient to reconstruct the course. Flag steps with <10 minutes sleep as limited interpretability.)

• Pressure Step 1:

  • Mode: [CPAP / BPAP S / BPAP S/T]; Pressure: [CPAP cm H2O / EPAP/IPAP cm H2O]
  • Time asleep: [hh:mm]; REM: [yes / no]; Supine: [yes / no]
  • Residual AHI: [value] ([3%/arousal / 4% criterion])
  • SpO2 mean: [%]; Nadir: [%]
  • Leak: [minimal / mild / moderate / severe] (quantitative [L/min] if available)

• Pressure Step 2:

  • Mode: [CPAP / BPAP S / BPAP S/T]; Pressure: [settings]
  • Time asleep: [hh:mm]; REM: [yes / no]; Supine: [yes / no]
  • Residual AHI: [value]; SpO2 mean/nadir: [%]/[%]; Leak: [assessment]
• (Add additional pressure steps as needed.)

Narrative Summary:

• [Drivers of pressure increases]
• [Setting at which obstructive events were controlled; REM-supine achieved at that pressure: yes / no]
• [Treatment-emergent central apneas: present / absent; if present, settings observed and CAI]
• [Leak as limiting factor and mitigation attempts]
• [Oxygenation course and whether SpO2 normalized]

Oxygenation and Ventilation

• SpO2: Mean [%]; Nadir [%]; Time <90%: [min or %TST]; ODI: [events/hour]
• Supplemental O2: [Room air throughout / Supplemental oxygen at (flow) L/min]. (If used: indication, starting flow, titration steps, final flow.)
• CO2 Monitoring: [Not monitored / ETCO2 / TcCO2]. (If monitored: baseline, maximum, time above threshold with relation to sleep stage and PAP settings.)

Cardiac and Movement Findings

Cardiac: Mean sleeping HR [bpm], [rhythm]. [Clinically significant arrhythmias if any, or "No sustained arrhythmia observed" if ECG quality adequate]. ECG signal quality: [adequate / limited].

Periodic Limb Movements: (Include only if PLMs scored and present.) PLM index: [events/hour]; PLM arousal index: [events/hour].

Technical Quality and Limitations

• [Overall signal quality and notable artifacts]
• [Mask leak issues and mitigation attempts]
• [Patient tolerance issues and actions taken]
• [Explicit limitations affecting confidence: insufficient supine REM at effective pressure / high leak limiting interpretability above (pressure) / short TST / CO2 not monitored despite clinical suspicion]

Impression

• Obstructive sleep apnea: [Mild / moderate / severe] — [established by prior testing (date) / established by baseline segment this study]. AHI [value] ([scoring rule]).
• Treatment-emergent central sleep apnea: [Present (CAI, settings observed) / Absent]
• Hypoxemia requiring supplemental oxygen: [Present (flow requirements) / Absent]
• Other findings: [PLMD / hypoventilation / other, or "None"]

Titration Outcome: [Final mode and settings]. Residual AHI [value] at final setting. SpO2 [acceptable / required supplemental O2]. REM-supine at final pressure: [achieved / not achieved]. Titration Grade: [Optimal / Good / Adequate / Unacceptable] — [brief rationale].

Recommendations

PAP Prescription:

• Mode: [CPAP (pressure) cm H2O / APAP (min)–(max) cm H2O / BPAP (S / S/T) EPAP (value), IPAP (value), backup rate (bpm) if applicable]
• Interface: [type, size]; Chin strap: [yes / no]; Heated humidification: [yes / no]
• Supplemental oxygen: [None / (flow) L/min via (delivery method)]

Follow-up:

• [Device data review timeline]
• [Early troubleshooting plan for adherence, leak, or pressure intolerance]
• [Escalation plan if residual symptoms, high leak, or elevated residual AHI]

Interpreting Clinician: [Name, credentials]

Signature: ____________________________    Date: [Date signed]