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Sleep study shows sharp increase in BPM, sudden onset of limb movement. Was hospitalized for depression. Worry?

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Hi, I am a 58 year old female. 5'5" 110 lbs. I recently had a sleep study done. I am concerned about the heart rate trend graph.
In a six hour period it shows to very sharp increases of bpm followed by three very sudden drops in bpm.
the increase and drops are between an hour to two hours apart.
Wake: XXXXXXX bpm 7680 - Mean bpm 57.4 - Min bpm - not noted
Non Rem: XXXXXXX bpm 640 - mean bpm 53.2 - Min bpm - 12.6
Rem: XXXXXXX bpm 147.7 - Mean bpm 54.7 - Min bpm - 13.7
Time range: > 100 bpm: Wake 3% - Non Rem 0.1% Rem 0.2%
90- 100 bpm: Wake0.9% - Non Rem 0% - Rem 0.1%
80 - 89 bpm: Wake 1% - Non Rem 0.1% - Rem 0.1%
70 - 79 bpm: Wake 3.5% - Non Rem 0% - Rem 0.1%
60 - 69 bpm: Wake 30.3% - Non Rem 3.7% - Rem9.1%
50 - 59 bpm: Wake 46.2% - Non Rem77.3% - Rem 85.7%
<50 bpm: Wake 15.1% - Non Rem 18.8% - Rem 4.6%
The Hypnogram shows I woke up instantly every time a sharp increase or drop happend - in all states of sleep
At 4:30 am there was a sudden onset of limb movements for 45 minutes- all limbs. With it a consistent fluctuation of HR witch a span of aprox. 40 bpm. This fluctuation continued even after limb movement stopped for rest of study almost 2 hr.
The analysis notes state: Alpha intrusions - Sinus rhythm and rib cage shift was noted through out the night.
also: No sleep apnea 25 hpopnias.
I called my doctor and spoke to the nurse about my concerns.
She called back and left message: nothing to worry had looked at all 3 pages ( report has 7 pages). I am afraid nobody really looked at this report. Is this Ok or do I need to worry? My father died sudden death at age 56. He was a very fit man.
Other medical history: diagnosed with bipolar2. No history of mania. Mainly hypo mania - hospitalized for 4 weeks this spring for depression. On 200mg Seroquel at night time.
3 unexplained falls this Summer - one ambulance trip to emergency - report: med reaction or seizure? refereed to neurologist. appointment in December.
Posted Mon, 7 May 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 20 hours later
Hello and Thanks for the query.

Regarding the sleep study report provided to me indicates fluctuations in the heart rate which drops to a significant low levels during sleep which is abnormal. You do not have any apneas, but have significant hypopneas. Frequent alpha intrusions indicate frequent arousal and fragmented sleep. All these indicate features of Obstructive sleep apnea. But we need to look in to the report if there is hypopnea followed by drop in the heart rate or saturation. If so correction of Sleep Apnea rectifies the problem.

Regarding the limb movements, it can be due to a Seizure or a Sleep Disorder. If it is a Seizure, the EEG electrodes attached picks up the changes. Absence of this in the report indicates it to be a probable Sleep Disorder.

Though complete report is not available to me, I personally feel you have Sleep Apnea Syndrome affecting the heart rate. You need detailed cardiac evaluation with a 24 hour Holter monitoring for documenting variable heart rates.

I am sorry, you are dealing with this frustrating problem and I hope you can find yourself in better health soon after consulting your Sleep Specilaist and Cardiologist. Till then try to sleep in the lateral or prone positions which avoids apnea to some extent. Avoid taking Sedatives or Tranquilizers.

I hope, this helps to solve your query. I will be available for follow up queries if any.

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