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CC BY-NC-ND 4.0 · Sleep Sci 2018; 11(01): 45-48
DOI: 10.5935/1984-0063.20180010
THEORETICAL ESSAYS

Apnea-hypopnea index in sleep studies and the risk of over-simplification

Authors

  • Eduardo Borsini

    1   Hospital Británico de Buenos Aires.
    4   Argentinian Group for Investigation and Study of Sleep Disorders (GAIAS).

  • Facundo Nogueira

    2   Hospital de Clínicas.
    4   Argentinian Group for Investigation and Study of Sleep Disorders (GAIAS).

  • Carlos Nigro

    3   Hospital Alemán.
    4   Argentinian Group for Investigation and Study of Sleep Disorders (GAIAS).
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According to recent reports, sleep disorders affect 30% of the adult population and 5-10% of children. Obstructive Sleep Apnea Hypopnea Syndrome (OSA) has a considerable epidemiological impact and demand for consultation is growing in our community. Therefore, it is necessary to know the principles of interpretation of diagnostic methods. A suspicion of OSA requires confirmation. According to the guidelines of the Argentine Association of Respiratory Medicine, polysomnography (PSG) is the gold standard for OSA diagnosis, while home sleep testing (HST) can be accepted as a comparatively effective method depending on the clinical situation of the patient. This article questions the use of AHI (apnea-hypopnea index) as the only measurement needed to diagnose OSA and assess its severity. In fact, it is surprising that, despite the large mass of data analyzed during sleep studies, current practices only focus on AHI. More than four decades have passed since OSA was first described. Our tendency to oversimplify complex conditions may prevent us from gaining a deeper and more thorough understanding of OSA. The development and validation of OSA severity scoring systems based on multiple parameters is still a pending issue.

Sleep Apnea Syndromes - Severity of Illness Index - Sleep Disorder


Publikationsverlauf

Eingereicht: 04. November 2017

Angenommen: 30. Januar 2018

Artikel online veröffentlicht:
13. Oktober 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. PMID: 23589584 DOI: http://dx.doi.org/10.1093/aje/kws342
  • 2 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441-6. DOI: http://dx.doi.org/10.1016/j.sleep.2009.10.005
  • 3 Goodwin JL, Vasquez MM, Silva GE, Quan SF. Incidence and remission of sleep-disordered breathing and related symptoms in 6- to 17-year old children-the Tucson Children’s Assessment of Sleep Apnea Study. J Pediatr. 2010;157(1):57-61. PMID: 20304429 DOI: http://dx.doi.org/10.1016/j.jpeds.2010.01.033
  • 4 World Health Organization. Report of WHO Consultation (WHO Technical Report Series) Obesity: preventing and managing the global epidemic. Online supplement [cited 2018 Feb 5]. Available from: http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/
  • 5 Elgart J, Pfirter G, Gonzalez L, Caporale J, Cormillot A, Chiappe ML, et al. Obesity in Argentina: epidemiology, morbimortality and economic impact. Rev Argent Salud Pública. 2010;1(5):6-12.
  • 6 Masa Jiménez JF, Barbé Illa F, Capote Gil F, Chiner Vives E, Díaz de Atauri J, Durán Cantolla J, et al.; Working Group. Recursos y demoras en el diagnóstico del síndrome de apneas-hipopneas durante el sueño (SAHS). Arch Bronconeumol. 2007;43(4):188-98. DOI: http://dx.doi.org/10.1157/13100537
  • 7 Rosen IM, Kirsch DB, Chervin RD, Carden KA, Ramar K, Aurora RN, et al.; American Academy of Sleep Medicine Board of Directors. Clinical Use of a Home Sleep Apnea Test: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med. 2017;13(10):1205-7. DOI: http://dx.doi.org/10.5664/jcsm.6774
  • 8 Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(3):479-504. DOI: http://dx.doi.org/10.5664/jcsm.6506
  • 9 Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465-84. PMID: 180875 DOI: http://dx.doi.org/10.1146/annurev.me.27.020176.002341
  • 10 Hudgel DW. “Apnea index”: need for improving the description of respiratory variability during sleep. Am Rev Respir Dis. 1986;133(4):708-9. PMID: 3083746
  • 11 Gould GA, Whyte KF, Rhind GB, Airlie MA, Catterall JR, Shapiro CM, et al. The sleep hypopnea syndrome. Am Rev Respir Dis. 1988;137(4):895-8. PMID: 3354998 DOI: http://dx.doi.org/10.1164/ajrccm/137.4.895
  • 12 Moser NJ, Phillips BA, Berry DT, Harbison L. What is hypopnea, anyway? Chest. 1994;105(2):426-8. PMID: 8306740
  • 13 Redline S, Sanders M. Hypopnea, a floating metric: implications for prevalence, morbidity estimates, and case finding. Sleep. 1997;20(12):1209-17. DOI: http://dx.doi.org/10.1093/sleep/20.12.1209
  • 14 Ruehland WR, Rochford PD, O'Donoghue FJ, Pierce RJ, Singh P, Thornton AT. The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep. 2009;32(2):150-7. DOI: http://dx.doi.org/10.1093/sleep/32.2.150
  • 15 Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al.; American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8(5):597-619.
  • 16 Rapoport DM. POINT: Is the Apnea-Hypopnea Index the Best Way to Quantify the Severity of Sleep-Disordered Breathing? Yes. Chest. 2016;149(1):14-6. PMID: 26181884 DOI: http://dx.doi.org/10.1378/chest.15-1319
  • 17 Ho V, Crainiceanu CM, Punjabi NM, Redline S, Gottlieb DJ. Calibration Model for Apnea-Hypopnea Indices: Impact of Alternative Criteria for Hypopneas. Sleep. 2015;38(12):1887-92. DOI: http://dx.doi.org/10.5665/sleep.5234
  • 18 Vijayan VK. Morbidities associated with obstructive sleep apnea. Expert Rev Respir Med. 2012;6(5):557-66. DOI: http://dx.doi.org/10.1586/ers.12.44
  • 19 Mannarino MR, Di Filippo F, Pirro M. Obstructive sleep apnea syndrome. Eur J Intern Med. 2012;23(7):586-93. DOI: http://dx.doi.org/10.1016/j.ejim.2012.05.013
  • 20 Usmani ZA, Chai-Coetzer CL, Antic NA, McEvoy RD. Obstructive sleep apnoea in adults. Postgrad Med J. 2013;89(1049):148-56. PMID: 23161914 DOI: http://dx.doi.org/10.1136/postgradmedj-2012-131340
  • 21 Heatley EM, Harris M, Battersby M, McEvoy RD, Chai-Coetzer CL, Antic NA. Obstructive sleep apnoea in adults: a common chronic condition in need of a comprehensive chronic condition management approach. Sleep Med Rev. 2013;17(5):349-55. DOI: http://dx.doi.org/10.1016/j.smrv.2012.09.004
  • 22 Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006;(1):CD001106.
  • 23 Ernst G, Bosio M, Salvado A, Dibur E, Nigro C, Borsini E. Difference between apnea-hypopnea index (AHI) and oxygen desaturation index (ODI): proportional increase associated with degree of obesity. Sleep Breath. 2016;20(4):1175-83. DOI: http://dx.doi.org/10.1007/s11325-016-1330-3
  • 24 Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest. 2015;147(1):266-74. DOI: http://dx.doi.org/10.1378/chest.14-0500
  • 25 Marshall NS, Wong KK, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med. 2014;10(4):355-62. DOI: http://dx.doi.org/10.5664/jcsm.3600
  • 26 Punjabi NM, Newman AB, Young TB, Resnick HE, Sanders MH. Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas. Am J Respir Crit Care Med. 2008;177(10):1150-5. PMID: 18276938 DOI: http://dx.doi.org/10.1164/rccm.200712-1884OC
  • 27 Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107(20):2589-94. PMID: 12743002
  • 28 Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352(12):1206-14. DOI: http://dx.doi.org/10.1056/NEJMoa041832
  • 29 Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, Ensrud KE, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011;306(6):613-9. PMID: 21828324 DOI: http://dx.doi.org/10.1001/jama.2011.1115
  • 30 Martínez-García MA, Durán-Cantolla J, Montserrat JM. [Sleep apnea-hypopnea syndrome in the elderly]. Arch Bronconeumol. 2010;46(9):479-88. Spanish. PMID: 20580480
  • 31 McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, et al.; SAVE Investigators and Coordinators. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med. 2016;375(10):919-31. PMID: 27571048 DOI: http://dx.doi.org/10.1056/NEJMoa1606599
  • 32 Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, Martínez-Alonso M, Carmona C, Barceló A, et al.; Spanish Sleep and Breathing Network. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;307(20):2161-8. PMID: 22618923
  • 33 Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-8. DOI: http://dx.doi.org/10.1016/S2213-2600(15)00043-0
  • 34 Kendzerska T, Gershon AS, Hawker G, Leung RS, Tomlinson G. Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2014;11(2):e1001599.
  • 35 Yalciner G, Babademez MA, Gul F. Association of sleep time in supine position with apnea-hypopnea index as evidenced by successive polysomnography. Sleep Breath. 2017;21(2):289-94. DOI: http://dx.doi.org/10.1007/s11325-016-1401-5
  • 36 Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju ShN, Wormser D, Gao P, Kaptoge S, Berrington de Gonzalez A, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388(10046):776-86. DOI: http://dx.doi.org/10.1016/S0140-6736(16)30175-1
  • 37 Le Bon O, Hoffmann G, Tecco J, Staner L, Noseda A, Pelc I, et al. Mild to moderate sleep respiratory events: one negative night may not be enough. Chest. 2000;118(2):353-9. DOI: http://dx.doi.org/10.1378/chest.118.2.353
  • 38 Mjid M, Ouahchi Y, Toujani S, Snen H, Ben Salah N, Ben Hmida A, et al. [Night-to-night variability of the obstructive sleep apnoea-hypopnoea syndrome]. Rev Mal Respir. 2016;33(9):775-80. French. DOI: http://dx.doi.org/10.1016/j.rmr.2016.04.023
  • 39 Masa JF, Corral J, Pereira R, Duran-Cantolla J, Cabello M, Hernández-Blasco L, et al.; Spanish Sleep Network. Therapeutic decision-making for sleep apnea and hypopnea syndrome using home respiratory polygraphy: a large multicentric study. Am J Respir Crit Care Med. 2011;184(8):964-71. PMID: 21737584 DOI: http://dx.doi.org/10.1164/rccm.201103-0428OC