Revise Respiratory Event Criteria or Revise Severity Thresholds for Sleep Apnea Definition?

Penzel, Thomas; Schöbel, Christoph; Fietze, Ingo

doi:10.5664/jcsm.5262

Cited by 18 publications

(9 citation statements)

References 11 publications

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“…The current AHI thresholds (5-15-30 events per hr) used for the severity classification of OSA lack thorough examination and strong clinical evidence; they are simply suggestions that have become the clinical standard over decades (AASM, 1999;Patil et al, 2007;Penzel et al, 2015). Despite the common use of the AHI thresholds, no comprehensive studies exist on whether the present classification is optimal for differentiating patients with the highest risk of OSA-related severe health consequences, such as an increased risk of mortality.…”

Section: Introductionmentioning

confidence: 99%

Mortality‐risk‐based apnea–hypopnea index thresholds for diagnostics of obstructive sleep apnea

Korkalainen

Töyräs

Nikkonen

et al. 2019

Journal of Sleep Research

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Summary The severity of obstructive sleep apnea is clinically assessed mainly using the apnea–hypopnea index. Based on the apnea–hypopnea index, patients are classified into four severity groups: non‐obstructive sleep apnea (apnea–hypopnea index < 5); mild (5 ≤ apnea–hypopnea index < 15); moderate (15 ≤ apnea–hypopnea index < 30); and severe obstructive sleep apnea (apnea–hypopnea index ≥ 30). However, these thresholds lack solid clinical and scientific evidence. We hypothesize that the current apnea–hypopnea index thresholds are not optimal despite their global use, and aim to assess this clinical shortcoming by optimizing the thresholds with respect to the risk of all‐cause mortality. We analysed ambulatory polygraphic recordings of 1,783 patients with suspected obstructive sleep apnea (mean follow‐up 18.3 years). We simulated 79,079 different threshold combinations in 100 randomized subgroups of the population and studied the relative risk of all‐cause mortality corresponding to each combination and randomization. The optimal thresholds were chosen according to three criteria: (a) the hazard ratios increase linearly between severity groups towards more severe obstructive sleep apnea; (b) each group includes at least 15% of the study population; (c) group sizes decrease with increasing obstructive sleep apnea severity. The risk of all‐cause mortality varied greatly across simulations; the threshold defining non‐obstructive sleep apnea group having the largest effect on the hazard ratios. The apnea–hypopnea index threshold combination of 3‐9‐24 was optimal in most of the subgroups. In conclusion, the assessment of obstructive sleep apnea severity based on the current apnea–hypopnea index thresholds is not optimal. Our novel approach provides methods for optimizing apnea–hypopnea index‐based severity classification, and the revised thresholds better differentiate patients into severity groups, ensuring that an increase in the severity corresponds to an increase in the risk of all‐cause mortality.

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Section: Introductionmentioning

confidence: 99%

Mortality‐risk‐based apnea–hypopnea index thresholds for diagnostics of obstructive sleep apnea

Korkalainen

Töyräs

Nikkonen

et al. 2019

Journal of Sleep Research

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“…These findings are explained, at least in part, by an overestimate of sleep time when EEG data are not available [ 14 ]. An additional source of variability stems from rules used to define hypopnoeas, as summarised by Penzel et al [ 15 ]. The 2012 American Academy of Sleep Medicine (AASM) guidelines defined hypopnoeas as a ≥30% decrease in nasal flow with ≥3% desaturation of arterial oxygen measured by pulse oximetry or EEG arousal.…”

Section: Management Of Sleep Apnoeamentioning

confidence: 99%

Sleep apnoea

2016

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“…However, only a small portion of the information recorded is used to assess the severity of OSA; i.e., the diagnosis relies almost exclusively on the AHI. Furthermore, based on the AHI, the severity of OSA is classified into four arbitrarily defined categories (AHI < 5, non-OSA; 5 ≤ AHI < 15, mild OSA; 15 ≤ AHI < 30, moderate OSA; AHI ≥ 30, severe OSA) [12,15]. Nonetheless, it has been reported that this classification might not be optimal for estimating the risk of OSA-related all-cause mortality [16].…”

Section: Introductionmentioning

confidence: 99%

Polysomnographic characteristics of severe obstructive sleep apnea vary significantly between hypertensive and normotensive patients of both genders

et al. 2020

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Purpose Hypertension is a common finding in patients with obstructive sleep apnea (OSA), but it has remained unclear whether or not the amount of disturbed breathing and characteristics of individual respiratory events differ between hypertensive and normotensive patients with severe OSA. Methods Full polysomnographic recordings of 323 men and 89 women with severe OSA were analyzed. Differences in the duration of individual respiratory events, total apnea and hypopnea times, and the percentage of disturbed breathing from total sleep time (AHT%) were compared between normotensive and hypertensive patients separately by genders. Furthermore, differences in the respiratory event characteristics were assessed between three AHT% groups (AHT% ≤ 30%, 30% < AHT% ≤ 45%, and AHT% > 45%). Results Hypertensive women had lower percentage apnea time (15.2% vs. 18.2%, p = 0.003) and AHT% (33.5% vs. 36.5%, p = 0.021) when compared with normotensive women. However, these differences were not observed between hypertensive and normotensive men. Percentage hypopnea time was higher in hypertensive men (13.5% vs. 11.2%, p = 0.043) but not in women (15.2% vs. 12.2%, p = 0.130) compared with their normotensive counterparts. The variation in AHI explained 60.5% (ρ = 0.778) and 65.0% (ρ = 0.806) of the variation in AHT% in normotensive and hypertensive patients, respectively. However, when AHT% increased, the capability of AHI to explain the variation in AHT% declined. Conclusions There is a major inter-and intra-gender variation in percentage apnea and hypopnea times between hypertensive and normotensive patients with severe OSA. OSA is an important risk factor for hypertension and thus, early detection and phenotyping of OSA would allow timely treatment of patients with the highest risk of hypertension.

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Revise Respiratory Event Criteria or Revise Severity Thresholds for Sleep Apnea Definition?

Cited by 18 publications

References 11 publications

Mortality‐risk‐based apnea–hypopnea index thresholds for diagnostics of obstructive sleep apnea

Mortality‐risk‐based apnea–hypopnea index thresholds for diagnostics of obstructive sleep apnea

Sleep apnoea

Polysomnographic characteristics of severe obstructive sleep apnea vary significantly between hypertensive and normotensive patients of both genders

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