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Sleep apnea diagnosis varies with the hypopnea criteria applied

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Abstract

Purpose

We aimed to evaluate the three hypopnea criteria, A and B from 2007 and the revised from 2012, proposed by the American Academy of Sleep Medicine (AASM) for scoring sleep-related breathing disorders (SRBDs) in patients with acute stroke or transient ischemic attack (TIA).

Methods

Polysomnographies (PSGs) in patients with TIA or stroke were scored according to the A-, B-, and 2012-hypopnea criteria.

Results

Sixty-three PSGs were eligible for hypopnea scoring. There was no difference in the number of patients diagnosed with the B- and 2012-criteria. Therefore, they are mentioned as one. Forty-seven patients (75 %) were diagnosed with SRBD using the A-criteria versus 57 patients (90 %) using the B/2012-criteria (p < 0.0016). In 30 cases, a change from A- to B/2012-criteria resulted in a change in diagnosis. Ten cases of “no SRBD” changed to mild/moderate/severe SRBD. An apnea hypopnea index (AHI) >15 is a typical indication of treatment. With the B/2012-criteria, we found an additional indication of treatment in 18 patients, compared to when the A-criteria were applied (p < 0.0001). Two of these patients were labeled as no SRBD with the A-criteria.

Conclusion

The difference is significant between the AHIs achieved by the A- and the B-/2012-hypopnea criteria, with much lower AHIs achieved with the A-criteria. As SRBD treatment lessens the risk of complications, correct identification of SRBD patients is of the utmost importance.

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Abbreviations

AASM:

American Academy of Sleep Medicine

AHI:

Apnea hypopnea index

BMI:

Body mass index

CSA:

Central sleep apnea

CSR:

Cheyne-Stokes respiration

CT:

Computed tomography

EEG:

Electroencephalography

ESS:

Epworth Sleepiness Scale

HI:

Hypopnea index

MRI:

Magnetic resonance imaging

OSA:

Obstructive sleep apnea

PSG:

Polysomnography

SRBD:

Sleep-related breathing disorder

SRCC:

Spearman’s rank correlation coefficient

TIA:

Transient ischemic attack

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Acknowledgments

The authors thank sleep technician Mia Dyhr for setting up some of the PSGs for this study and sleep technician Helle Leonthin for discussing difficult scoring cases. We would also like to thank Sune Birch, M.Sc., for the statistical analyses and Margit Graves Ponsaing, M.A., for proof-reading the manuscript. We are also thankful to the Department of Neurology and the Department of Clinical Neurophysiology, Rigshospitalet. There are no conflicts of interest among the authors. The authors have no further financial disclosures to make.

Compliance with ethical standards

As the PSGs were part of a clinical procedure, the Institutional Review Board (Ethics Committee) did not require a written patient consent. Informed, oral consent was obtained from all patients or their next of kin. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no competing interest.

Author information

Authors and Affiliations

  1. Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark

    Laura B. Ponsaing & Poul Jennum

  2. The Stroke Unit, Department of Neurology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark

    Helle K. Iversen

  3. Center for Healthy Aging, Copenhagen University, Copenhagen, Denmark

    Laura B. Ponsaing & Poul Jennum

Authors
  1. Laura B. Ponsaing
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  2. Helle K. Iversen
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  3. Poul Jennum
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Correspondence to Laura B. Ponsaing.

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Ponsaing, L.B., Iversen, H.K. & Jennum, P. Sleep apnea diagnosis varies with the hypopnea criteria applied. Sleep Breath 20, 219–226 (2016). https://doi.org/10.1007/s11325-015-1210-2

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  • DOI: https://doi.org/10.1007/s11325-015-1210-2

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