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Effect of different oxygen desaturation threshold levels on hypopnea scoring and classification of severity of sleep apnea

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Abstract

Purpose

Recently, there has been a debate about the rules used to score hypopnea events. The purpose of this study was to examine the effect of different oxygen desaturation threshold (ODT) levels on the apnea-hypopnea index (AHI) and on a recently introduced parameter, adjusted AHI. Adjusted AHI incorporates the severity of individual breathing cessation events. We also aimed to clarify the impact of the different ODT levels on the current classification of obstructive sleep apnea (OSA) severity.

Methods

Ambulatory polygraphic recordings of 68 patients (19 F/49 M, median age 53.2 years, AHI ≥5) were analyzed retrospectively. Hypopneas were defined as ≥30 % drop in airflow for ≥10 s associated with ≥2 % oxygen desaturation (ODT2%), and after that, using stricter ODT criteria (ODT3%–ODT8%).

Results

Compared to ODT4%, the ODT3% resulted in 5.6 events/h higher median conventional AHI, but only 1.5 events/h higher median adjusted AHI. A significant rearrangement of patients between the clinical severity categories took place when using different ODTs. When assessing with ODT3% instead of ODT4%, the portion of the patients with moderate or severe OSA (AHI ≥15) raised from 29.4 to 73.5 % using conventional AHI, but only marginally, i.e., from 73.5 to 77.9 %, using the adjusted AHI.

Conclusions

The conventional AHI was found to be susceptible even to minor changes in ODT level which may lead to substantial variability in AHI-based classification of disease severity. Since the adjusted AHI comprises information on severity of individual breathing cessations, it reduces the variability related to ODT levels used in hypopnea scoring and can increase the accuracy of estimation of OSA severity.

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References

  1. American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689

    Google Scholar 

  2. Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF, for the American Academy of Sleep Medicine (2007) The AASM Manual for the Scoring of Sleep and Associated Events: Rules, terminology and technical specifications. American Academy of Sleep Medicine, Westchester

    Google Scholar 

  3. Berry RB, Budhiraja R, Gottlieb DJ, American Academy of Sleep Medicine et al (2012) 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 8:597–619

    PubMed Central  PubMed  Google Scholar 

  4. Collop N, Anderson WM, Boehlecke B, Portable Monitoring Task Force of the American Academy of Sleep Medicine et al (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 3:737–747

    PubMed  Google Scholar 

  5. Collop NA (2008) Portable monitoring for the diagnosis of obstructive sleep apnea. Curr Opin Pulm Med 14:525–529

    Article  PubMed  Google Scholar 

  6. Redline S, Kapur VK, Sanders MH (2000) Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment. Am J Respir Crit Care Med 161:369–374

    Article  CAS  PubMed  Google Scholar 

  7. Manser RL, Rochford P, Pierce RJ, Byrnes GB, Campbell DA (2001) Impact of different criteria for defining hypopneas in the apnea-hypopnea index. Chest 120:909–914

    Article  CAS  PubMed  Google Scholar 

  8. Stepnowsky CJ Jr, Orr WC, Davidson TM (2004) Nightly variability of sleep-disordered breathing measured over 3 nights. Otolaryngol Head Neck Surg 131:837–843

    Article  PubMed  Google Scholar 

  9. Ruehland WR, Rochford PD, O’Donoghue FJ, Pierce RJ, Singh P, Thornton AT (2009) The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 32:150–157

    PubMed Central  PubMed  Google Scholar 

  10. Mehra R, Benjamin EJ, Shahar E et al (2006) Sleep Heart Health Study. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 173:910–916

    Article  PubMed Central  PubMed  Google Scholar 

  11. Bahammam AS, Obeidat A, Barataman K, Bahammam SA, Olaish AH, Sharif MM (2014) A comparison between the AASM 2012 and 2007 definitions for detecting hypopnea. Sleep Breath. doi:10.1007/s11325-014-0939-3

    PubMed  Google Scholar 

  12. Punjabi NM, Newman AB, Young TB, Resnick HE, Sanders MH (2008) Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas. Am J Respir Crit Care Med 177:1150–1155

    Article  PubMed Central  PubMed  Google Scholar 

  13. Mehra R, Stone KL, Varosy PD et al (2009) Nocturnal arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study. Arch Intern Med 169:1147–1155

    Article  PubMed Central  PubMed  Google Scholar 

  14. Redline S, Yenokyan G, Gottlieb DJ (2010) Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 182:269–277

    Article  PubMed Central  PubMed  Google Scholar 

  15. Stamatakis K, Sanders MH, Caffo B et al (2008) Fasting glycemia in sleep disordered breathing: lowering the threshold on oxyhemoglobin desaturation. Sleep 31:1018–1024

    PubMed Central  PubMed  Google Scholar 

  16. Muraja-Murro A, Nurkkala J, Tiihonen P et al (2012) Total duration of apnea and hypopnea events and average desaturation show significant variation in patients with a similar apnea–hypopnea index. J Med Eng Technol 36:393–398

    Article  CAS  PubMed  Google Scholar 

  17. Kulkas A, Tiihonen P, Julkunen P, Mervaala E, Toyras J (2013) Novel parameters indicate significant differences in severity of obstructive sleep apnea with patients having similar apnea–hypopnea index. Med Biol Eng Comput 51:697–708

    Article  PubMed  Google Scholar 

  18. Otero A, Felix P, Presedo J, Zamarron C (2012) An evaluation of indexes as support tools in the diagnosis of sleep apnea. Ann Biomed Eng 40:1825–1834

    Article  PubMed  Google Scholar 

  19. Kulkas A, Leppanen T, Sahlman J et al (2013) Novel parameters reflect changes in morphology of respiratory events during weight loss. Physiol Meas 34:1013–1026

    Article  CAS  PubMed  Google Scholar 

  20. Muraja-Murro A, Kulkas A, Hiltunen M et al (2014) Adjustment of apnea-hypopnea index with severity of obstruction events enhances detection of sleep apnea patients with the highest risk of severe health consequences. Sleep Breath 18:641–647

    Article  CAS  PubMed  Google Scholar 

  21. Kulkas A, Leppänen T, Sahlman J et al (2014) Weight loss alters severity of individual nocturnal respiratory events depending on sleeping position. Physiol Meas 19:2037–2052

    Article  Google Scholar 

  22. Tuomilehto H, Seppa J, Partinen M et al (2009) Lifestyle intervention with weight reduction-first line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 79:320–327

    Article  Google Scholar 

  23. Muraja-Murro A, Kulkas A, Hiltunen M et al (2013) The severity of individual obstruction events is related to increased mortality rate in severe obstructive sleep apnea. J Sleep Res 22:663–669

    Article  PubMed  Google Scholar 

  24. AASM suspends required use of 3 percent hypopnea desaturation scoring criterion. (August 27, 2013) American Academy of Sleep Medicine. http://www.aasmnet.org/articles.aspx?id = 4132. Accessed May 5, 2014

  25. Elshaug AG, Moss JR, Southcott AM, Hiller JE (2007) Redefining success in airway surgery for obstructive sleep apnea: a meta-analysis and synthesis of the evidence. Sleep 30:461–467

    PubMed  Google Scholar 

  26. Zafar S, Ayappa I, Norman RG, Krieger AC, Walsleben JA, Rapoport DM (2005) Choice of oximeter affects apnea-hypopnea index. Chest 127:80–88

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was financially supported by the Kuopio University Hospital (VTR-funding, projects 5041732, 5041733, 5041748) and Seinäjoki Central Hospital (VTRfunding, projects 3040 and 3114). K. Myllymaa is supported by the Finnish Cultural Foundation of Northern Savo and Finnish Brain Foundation.

Ethical statement

The study protocol was reviewed by the Research Ethics Committee of the Hospital District of Northern Savo, Kuopio, Finland (favorable opinion 127/2004). The patients were given both oral and written information about the study protocol, and they provided a signed informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Sami Myllymaa.

Additional information

Sami Myllymaa and Katja Myllymaa contributed equally to the paper

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Myllymaa, S., Myllymaa, K., Kupari, S. et al. Effect of different oxygen desaturation threshold levels on hypopnea scoring and classification of severity of sleep apnea. Sleep Breath 19, 947–954 (2015). https://doi.org/10.1007/s11325-015-1118-x

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  • DOI: https://doi.org/10.1007/s11325-015-1118-x

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