Outcome measurements in obstructive sleep apnea: Beyond the apnea‐hypopnea index

Tam, Samantha; Woodson, B. Tucker; Rotenberg, Brian

doi:10.1002/lary.24275

Cited by 48 publications

(45 citation statements)

References 26 publications

(118 reference statements)

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“…Additionally, PSG parameters including AHI, AI, RDI, and supine AI also significantly improved postoperatively compared to those in preoperative PSG regardless of using AASM 2007Rec and AASM 2012Rec criteria. Our results support other previous studies showing that the surgical treatment is effective in improving the subjective symptoms as well as objective severity of OSA . Furthermore, our results demonstrated significant differences in the AHI, HI, RERA, RDI, and supine AHI between AASM 2007Rec and AASM 2012Rec criteria.…”

Section: Discussionsupporting

confidence: 91%

“…Optimal treatment for OSA is as critical as prompt diagnosis for improved patients’ health and quality of life. The optimal treatment method is generally determined according to the patient's anatomical structures, PSG parameters, and personal preferences . Additionally, the success rate of each treatment option is one of the factors that can be considered to choose the proper treatment option for OSA patients .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, AASM 2012Rec tends to detect hypopnea more sensitively relative to AASM 2007Rec . AHI is the most commonly utilized surrogate marker in the diagnosis of OSA, grading of its severity, decision to treat, estimation of OSA prevalence, relationship between OSA and the risk of developing comorbidities, and comparison of the effects of treatment options . Because of the tendency to score more sensitively for the HI in AASM 2012Rec , the average AHI of patients is increased, which leads to an increase in the number of patients diagnosed with OSA, and the severity of OSA also tends to be determined as more severe.…”

Section: Discussionmentioning

confidence: 99%

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Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

et al. 2019

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Objectives To assess the impact of the American Academy of Sleep Medicine (AASM) 2012Rec criteria on the surgical success rate and polysomnography (PSG) parameters of patients with obstructive sleep apnea (OSA). Study Design A prospective clinical trial. Methods A total of 60 patients who performed surgery for treatment of OSA at the sleep breathing disorder center of a tertiary referral university hospital from October 1, 2015, to September 30, 2016, were enrolled. Preoperative and postoperative PSG were performed and scored using AASM 2007Rec and AASM 2012Rec. Surgical success was determined by criteria 1 (postoperative Apnea‐Hypopnea Index [AHI] <20% and 50% reduction) and criteria 2 (postoperative AHI <10), and surgical success rates according to AASM 2007Rec and AASM 2012Rec were compared. Results PSG parameters including AHI, hypopnea index, respiratory effort‐related arousals, respiratory disturbance index, and supine AHI scored significantly higher with AASM 2012Rec compared to AASM 2007Rec criteria, both preoperatively and postoperatively (all P < 0.05). Furthermore, when compared to the AASM 2007Rec criteria, AASM 2012Rec resulted in increased proportion of patients with severe OSA (70.0% vs. 95.0%; P < 0.001). For the surgical outcomes, AASM 2012Rec showed significantly lower surgical success rate both in criteria 1 (51.7% vs. 38.3%) and criteria 2 (35.0% vs. 18.3%) compared to the AASM 2007Rec, respectively (P < 0 .05). Conclusions This study demonstrated that AASM 2012Rec tends to decrease the success rate of surgical outcome for OSA patients, suggesting that defining success of surgical treatment for OSA could be changed dramatically according to the hypopnea scoring criteria. Level of Evidence 4 Laryngoscope, 130:825–831, 2020

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

et al. 2019

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“…In addition, previous studies have shown that AHI is poorly associated with many of the classical symptoms and the physiology of OSA as measured by, for example, quality of life, sleepiness and performance [11,12].…”

Section: Introductionmentioning

confidence: 99%

Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms

et al. 2015

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The aim was to assess the prevalence of obstructive sleep apnoea (OSA) as defined by an apnoea-hypopnea index (AHI) ⩾15 in the middle-aged general population, and the interrelationship between OSA, sleep-related symptoms, sleepiness and vigilance.A general population sample of 40-65-year-old Icelanders was invited to participate in a study protocol that included a type 3 sleep study, questionnaire and a psychomotor vigilance test (PVT).Among the 415 subjects included in the study, 56.9% had no OSA (AHI <5), 24.1% had mild OSA (AHI 5-14.9), 12.5% had moderate OSA (AHI 15-29.9), 2.9% had severe OSA (AHI ⩾30) and 3.6% were already diagnosed and receiving OSA treatment. However, no significant relationship was found between AHI and subjective sleepiness or clinical symptoms. A relationship with objective vigilance assessed by PVT was only found for those with AHI ⩾30. Subjects already on OSA treatment and those accepting OSA treatment after participating in the study were more symptomatic and sleepier than others with similar OSA severity, as assessed by the AHI.In a middle-aged general population, approximately one in five subjects had moderate-to-severe OSA, but the majority of them were neither symptomatic nor sleepy and did not have impaired vigilance. @ERSpublications Overall, 15% of the general population had untreated OSA without symptoms, sleepiness or decreased vigilance http://ow.ly/StiqS

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“…Moreover, recent evidence has shown significant discordance between the levels of AHI used to denote outcomes of therapy and real world clinical outcomes such as QOL, patient perception of disease, cardiovascular measures, disease burden and/or survival [1][2][3][4][5]. There is a mountain of evidence showing how the AHI can vary from night to night, vary from laboratory to laboratory, from various nasal thermistor to pressure transducers, and AHI can vary based on the different definitions of hypopnea used in different laboratories and software [6][7][8][9][10][11][12][13][14].…”

Section: Dear Editormentioning

confidence: 99%

The SLEEP GOAL as a success criteria in obstructive sleep apnea therapy

Pang¹,

Rotenberg

2016

Eur Arch Otorhinolaryngol

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Obstructive sleep apnea (OSA) is a common illness affecting 9 % of middle age men in North America and 3 % of women [1]. It is a debilitating disorder that affects the patients primarily at night, but manifests mainly in the daytime. The snoring at night affects not only the bedpartner's sleep quality, but may also cause break down in the marriage and relationship. Tiredness, poor concentration and irritability disrupt the snorer's quality of life, work and productivity. This seemingly innocuous five-letter word, sleep, affects the patient's mood, temper, emotional state, relationships, work performance, promotions, monthly salary and his entire being/life.Successfully and holistically treating a patient with OSA would imply reversing debilitating symptoms faced by the patient, including the metabolic and oxidative stress that accompanies the disease load and disease burden. Moreover, recent evidence has shown significant discordance between the levels of AHI used to denote outcomes of therapy and real world clinical outcomes such as QOL, patient perception of disease, cardiovascular measures, disease burden and/or survival [1][2][3][4][5]. There is a mountain of evidence showing how the AHI can vary from night to night, vary from laboratory to laboratory, from various nasal thermistor to pressure transducers, and AHI can vary based on the different definitions of hypopnea used in different laboratories and software [6][7][8][9][10][11][12][13][14]. The contemporary reliance on AHI as generally the only outcome measure assessed in research programs is not in line with many other aspects of medicine that are becoming patient centered as opposed to test centered [6][7][8][9][10][11][12][13][14].According to the surgical literature on OSA treatment, Sher's success criteria of 50 % reduction in AHI and an AHI less than 20 tend to be the benchmark for success [15]. However, this archaic concept was based entirely on an arbitrary AHI number that did not stratify the patients by likelihood of surgical success. These oft-quoted criteria should be abandoned as being both insufficient and out of date. Hobson et al. recently showed in a creative study that differences even in the definition of AHI severity cut-off can greatly influence reported efficacy of surgery in patients with OSA [16]. For example, a patient with preoperative AHI of 95 who has a post-operative PSG showing an AHI of 21, would likely experience significant symptomatic clinical improvement with a huge decrease in disease burden (in terms of obesity, hypertension, cardiovascular effects) even though they are not, by definition, considered a successful surgical outcome by the numerical AHI criteria, whereas a patient with a pre-operative AHI of 35, reduced post-operatively to under 14, is considered a successful AHI outcome even though the likelihood of clinical cardiovascular, disease burden and/or QOL impact may be minimal. It is essential that OSA treatment has clinical significance rather than satisfy some numerical criteria.When considering OSA treatm...

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Outcome measurements in obstructive sleep apnea: Beyond the apnea‐hypopnea index

Abstract: The literature shows a range of tools based on symptoms and physiology of OSA that can assess effects of treatment. Assessment of surgical treatment for OSA should neither be limited to AHI as an outcome, nor should this be the only outcome stressed.

Cited by 48 publications

References 26 publications

Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms

The SLEEP GOAL as a success criteria in obstructive sleep apnea therapy

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