DS9 Document EFTA01108082

1 oft ACCLI SarTY HOME SLEEP TEST REPORT provided by NovaSorn" Patient Name: JEFFREY EPSTEIN Test ID: ORD-512625 Date of Birth: 01/20/1953 Dates of Study: 06/27/2014 Gender: Male Referring Clinician: BRUCE MOSKOWITZ, Height, Weight: 72.0 in, 200.0 lbs Ordering Clinician: BRUCE MOSKOWITZ, SSN Number: Interpreting Physician: Michael Coppola MD FCCP Symptoms This 61 y/o Male was referred for the following complaints: Snoring, Excessive Daytime Sleepiness BMI 27.12 inches, Neck Size Not provided, Epworth 16.00 Diagnosis: Moderate Obstructive Sleep Apnea (ICD-9: 327.23, ICD-10: G47.33) Interpretation and Recommendation `This study confirms the presence of physiologic events consistent with moderate obstructive sleep apnea (OSA) with frequent hypopneas and apneas. The diagnosis of obstructive sleep apnea syndrome requires the presence of historical data such as excessive daytime sleepiness or witnessed snoring and apneas at night in addition to sleep recordings documenting a significant level of sleep disordered breathing. This study confirms those criteria and treatment for sleep apnea is indicated. Auto-titrating CPAP (continuous positive airway pressure) or a CPAP titration would be appropriate. Other effective treatments which may be considered are oral appliances and otolaryngeal evaluation for treatable upper airway narrowing. Treatment would also include careful attention to proper sleep hygiene, weight reduction if the BMI is elevated, avoidance of sleeping in the supine position and avoidance of alcohol within four hours of bedtime. Specific treatment decisions should be tailored to each patient based upon the clinical situation and all treatment options should be considered. The patient should be instructed to avoid driving if sleepy and careful clinical follow up is needed to ensure that the patient's symptoms are improving with therapy and that PAP adherence is supported and measured if prescribed. Although different insurers have different requirements, as an example Medicare requires documentation that the patient is utilizing PAP therapy at least 4 hours per night for 70% of the nights during a 30 consecutive day period. The PAP device automatically collects this data and your DME (Durable Medical Equipment) provider can supply it to you. Interpreting Physician Signature Electronically signed by: Michael Coppola MD FCCP on Saturday June 28, 2014 at 03:28 PM [GMT] JEFFREY EPSTEIN, ORD-512625 NovaSom Inc. 877-753-3776 EFTA01108082 Page 2 of 2 Description of Procedure: This Sleep Apnea recording was performed utilizing a AccuSom Type III diagnostic device that simultaneously recorded oral/nasal airflow, chest wall motion by impedance, oxygen saturation (Nonin Pulse oximeter), heart rate, and snoring. The study took place over 1 nights. Data Total recorded time: 7.51 hours for 1 nights Total recorded minutes: 451.00 Highest AHI 3% (AASM criteria): 16.7 Highest AHI 4% (Medicare Criteria): 15.5 Night 1 Sleep Time: 07:31 Start 21:18 Stop 5:18 AHI 3% = 16.7, AHI 4% = 15.5 Total number of events @ 3%: 126 Total number of events @ 4%: 117 Total number of apneas: 116 Total number of hypopneas @ 3% criteria: 10 Total number of hypopneas @ 4% criteria: 1 Oximetry Oxygen saturation <90% for approximately: 0.4 minutes recorded time (0.1% of recorded time) Oxygen saturation >90% for approximately: 478.5 minutes recorded time Night 1 Oxygen desaturations <90%: 0.08% of recorded time Average heart rate: 49 b/m Lowest heart rate: 41 b/m I attest that I have reviewed the raw data acquired in this study and confirm that the sleep study was technically adequate, unless stated otherwise above, and sufficient to allow for my interpretation. Interpreting Physician Electronically signed by: Michael Coppola MD FCCP on Saturday June 28, 2014 Signature at 03:28 PM [GMT] Date 06/28/2014 Interpreting Physician Signature Electronically signed by: Michael Coppola MD FCC? on Saturday June 28, 2014 at 03:28 PM [GMT] JEFFREY EPSTEIN, ORD-512625 NovaSom Inc. 877-753-3776 EFTA01108083 NOVASOW SLEEP STUDY Night 1 Patient Name: JEFFREY E EPSTEIN Date of Birth: 01/20/1953 Test ID: 0RD-512625 Oi 90 80 X70 v)rn Csi c 60 o g (,)c 50 O2 Saturation (Top Plot Snoring Sound Levels (Bottom Plot) Apneas & Hypopneas 50 V I 40 30 17, a) 20 -J 10 0 25:18 A+H* Index (AHURDI**): 16.7 Study Duration: 7 hours 31 minutes Date of Study: June 27, 2014 FIRST FOUR HOURS V Obstructive Apnea <> Unclassified Apnea Hypopnea" 22:18 ca 90 2- -ru 80 TO 3 70 rn .c 60 0 E is 50 O2 Saturation (Top Plot) Snoring Sound Levels (Bottom Plot) Apneas & Hypopneas 23:18 SECOND FOUR HOURS 00:18 01:18 Obstructive Apnea Unclassified Apnea 1 Hypopnea" 50 7() 40 . 30 20 -J 10 01:18 V 02:18 3:18 04:18 05:18 OXYGEN SATURATION INFORMATION Saturation 100-95% 94-90% 89-85% 84-80% 79-70% <70% # Drops 0 9 0 0 0 0 Time (HH:MM) 01:53 06:04 < 1 min 00:00 00:00 00:00 Lowest O2 Sat was 89% (> 1 time); a "Drop" is >= 3% 02 fall. EVENT SUMMARY Event type Total# Events Avg. Duration Max. Duration #Events/Hr. Obstructive Apneas 113 35 sec 99 sec 15 Unclassified Apneas 3 32 sec 40 sec 0.4 Hypopneas * 10 30 sec 45 sec 1.3 Total # A+H * 126 16.7 *A hypopnea is defined as a 50% or more reduction in airflow for at least 10 seconds, accompanied by a decrease in blood oxygen saturation of at least 3% **AHI/RDI = sum of the apneas and hypopneas divided by the number of hours in the study. Copyright © 1997-2013 by NovaSom, Inc. All rights reserved. - NovaSom Study Viewer (8.2.1.0]. EFTA01108084 SLEEP STUDY SUMMARY Patient Name: JEFFREY E EPSTEIN Date of Birth: 01/20/1953 Test ID: ORD-512625 Physician: BRUCE MOSKOWITZ MD Night #1 Jun 27 2014 Device start time 21:03 Study start time 21:18 Study end time 05:18 Total study duration 07:31 Disconnects: # 0 Disconnect: (min) 0 Invalid respiratory signals: # 5 Invalid respiratory signal: (min) 27 Invalid O2 signal: (min) 1 Apnea + Hypopnea Index (AHI/RDI**) with >= 3% O2 desaturation 16.7 Total number of hypopneas with >= 3% O2 desaturation 10 Apnea + Hypopnea Index (AHI/RDI**) with >= 4% O2 desaturation 15.5 Total number of hypopneas with >= 4% O2 desaturation 1 Apnea Index (Al) 15.4 Total number of apneas 116 Obstructive apneas 113 Unclassified apneas* 3 Lowest O2 saturation Time of occurrence time below 90% saturation Heart Rate (bpm) 89% > 1 time 0% Minimum 41 Maximum 89 Average 49 Snoring/Respiration Noise Time over 50dBa (HH:MM) 05:33 °A) time over 50dBa 74% Maximum (dBa) 80.0 Average (dBa) 59.0 ** Unclassified apnea: apnea accompanied by a reduction in chest movement of greater than 90% compared to baseline movement. AHI/RDI = sum of the apneas and hypopneas divided by the number hours in the study. Copyright @ 1997-2013 by NovaSom. Inc. All rights reserved. - NovaSom Study Viewer [8.2.1.0), EFTA01108085