Advertisement

Sleep and Breathing

, Volume 20, Issue 4, pp 1175–1183 | Cite as

Difference between apnea-hypopnea index (AHI) and oxygen desaturation index (ODI): proportional increase associated with degree of obesity

  • G. Ernst
  • M. Bosio
  • A. Salvado
  • E. Dibur
  • C. Nigro
  • E. Borsini
Sleep Breathing Physiology and Disorders • Original Article

Abstract

Purpose

Obesity is one of the main predisposing factors for obstructive sleep apnea (OSA) hypopnea syndrome. It has been described that body mass index (BMI) influences the accuracy of oxygen desaturation index (ODI) for the diagnosis of OSA by polysomnography (PSG). We analyzed the relationship between traditional indicators: apnea-hypopnea index (AHI) and ODI in a population at high risk for OSA, by respiratory polygraphy (RP) and PSG.

Methods

This is a retrospective study of 1898 patients with suspicion of OSA, from which 1053 underwent RP and 582 underwent PSG with OSA. We compared results considering gender, age, and degree of obesity.

Results

This study included 1333 records of patients with OSA—more than 80 % of whom were overweight or obese. We observed that AHI and ODI increased progressively with obesity grade and said increase was associated with BMI only in men. The evaluation of the agreement between AHI and ODI found a difference between normal weight and obese patients, regardless of gender.

Conclusions

Study findings contribute to understand the role of oximetry in the diagnosis of OSA in obese patients. Our results were observed using full PSG and a simplified home method. The correlation between these indicators could improve our clinical interpretation of OSA severity among obese patients when abbreviated tests are used.

Keywords

Obesity Obstructive sleep apnea Respiratory polygraphy Polysomonography 

Notes

Compliance with ethical standards

Funding

No funding was received for this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Hospital Británico de Buenos Aires and Hospital Alemán committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Yaggi HK, Strohl KP (2010) Adult obstructive sleep apnea/hypopnea syndrome: definitions, risk factors, and pathogenesis. Clin Chest Med 31(2):179–186CrossRefPubMedGoogle Scholar
  2. 2.
    Swinburn BA, Sacks G, Hall KD, et al. (2011) The global obesity pandemic: shaped by global drivers and local environments. Lancet 378(9793):804–814CrossRefPubMedGoogle Scholar
  3. 3.
    Xu HJ, Lan XF, Li QY, et al. (2015) Factors affecting blood pressure profile in pre and postmenopausal women with obstructive sleep apnea hypopnea syndrome. Sleep and Breathing 19(1):169–174CrossRefPubMedGoogle Scholar
  4. 4.
    Report of a WHO Consultation (WHO Technical Report Series 894) Obesity: preventing and managing the global epidemic. Online supplement. http://www.who.int/gho/ncd/risk_factors/bmi_text/en/index.html
  5. 5.
    Elgart J, Pfirter G, Gonzalez L, et al. (2010) Obesity in Argentina: epidemiology, morbimortality and economic impact. Rev Argent Salud Pública 1:6–12Google Scholar
  6. 6.
    Arnardottir ES, Mackiewick M, Gislason T, Teff KL, Pack A (2009) Molecular signatures of obstructive sleep apnea in adults: a review and perspective. Sleep 32:447–470CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bonsignore MR, McNicholas WT, Montserrat JM, Eckel J (2012) Adipose tissue in obesity and obstructive sleep apnoea. Eur Respir J 39:746–767CrossRefPubMedGoogle Scholar
  8. 8.
    Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T (2005) Progression and regression of sleep-disordered breathing with changes in weight: the sleep heart health study. Arch Intern Med 165:2408–2413CrossRefPubMedGoogle Scholar
  9. 9.
    Schwartz A, Patil S, Laffan A, Polotsky V, Schneider H, Smith P (2008) Obesity and obstructive sleep apnea. Pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 5:185–192CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Serafini F, MacDowell A, Rosemurgy A, Strait T, Murr M (2001) Clinical predictors of sleep apnea in patients undergoing bariatric surgery. Obes Surg 11:28–31CrossRefPubMedGoogle Scholar
  11. 11.
    Ling I, James A, Hillman D (2012) Interrelationships between body mass, oxygen desaturation, and apnea-hypopnea indices in a sleep clinic population. Sleep 35:89–96CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Bixler EO, Vgontzas AN, Lin HM, et al. (2001) Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 163(3):608–613CrossRefPubMedGoogle Scholar
  13. 13.
    Block AJ, Wynne JW, Boysen PG (1980) Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women. Am J Med 69:75–79CrossRefPubMedGoogle Scholar
  14. 14.
    Chiner E, Arriero JM, Signes-Costa J, Marco J, Fuentes I (1999) Validation of the Spanish version of the Epworth Sleepiness Scale in patients with a sleep apnea syndrome. Arch Bronconeumol 35:422–427CrossRefPubMedGoogle Scholar
  15. 15.
    Iber C, Ancoli-Israel S, Chesson AL Jr, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  16. 16.
    Farre R, Rigau J, Montserrat JM, Buscemi L, Ballester E, Navajas D (2003) Static and dynamic upper airway obstruction in sleep apnea: role of the breathing gas properties. Am J Resp Crit Care Med 168:659–663CrossRefPubMedGoogle Scholar
  17. 17.
    O’Connor C, Thornley KS, Hanly PJ (2000) Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med 161:1465–1472CrossRefPubMedGoogle Scholar
  18. 18.
    Kripke DF, Ancoli-Israel S, Klauber MR, Wingard DL, Mason WJ, Mullaney DJ (1997) Prevalence of sleep-disordered breathing in ages 40-64 yr: a population-based survey. Sleep 20:65–76CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sil A, Barr G (2012) Assessment of predictive ability of Epworth scoring in screening of patients with sleep apnoea. J Laringol Otol 126(4):372–379CrossRefGoogle Scholar
  20. 20.
    Araghi MH, Jagielski A, Neira I, et al. (2013) The complex associations among sleep quality, anxiety-depression, and quality of life in patients with extreme obesity. Sleep 36:1859–1865CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Cambursano VH (2015) SAHOS, una vez más, favorecidas por la naturaleza. RAMR 3:161–163Google Scholar
  22. 22.
    Peppard PE, Ward NR, Morrell MJ (2009) The impact of obesity on oxygen desaturation during sleep-disordered breathing. Am J Respir Crit Care Med 180(8):788–793CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    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 8:597–519PubMedPubMedCentralGoogle Scholar
  24. 24.
    Redline S, Kapur VK, Sanders MH, et al. (2000) Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment. Am J Respir Crit Care Med 161:369–674CrossRefPubMedGoogle Scholar
  25. 25.
    Fredheim JM, Røislien J, Hjelmesth J (2014) Validation of a portable monitor for the diagnosis of obstructive sleep apnea in morbidly obese patients. J Clin Sleep Med 10:751–757PubMedPubMedCentralGoogle Scholar
  26. 26.
    Rapoport DM (2015) Point: is the AHI the best way to quantify the severity of sleep disordered breathing?—Yes. Chest. doi: 10.1378/chest.15-1319 Google Scholar
  27. 27.
    Chiner E, Signes-Costa J, Arriero JM, Marco J, Fuentes I, Sergado A (1999) Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax 54:968–971CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Nigro CA, Aimaretti S, Gonzalez S, Rhodius E (2009) Validation of the WristOx 3100 oximeter for the diagnosis of sleep apnea/hypopnea syndrome. Sleep Breath 13(2):127–136CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Hospital BritánicoBuenos AiresArgentina
  2. 2.Hospital AlemánBuenos AiresArgentina

Personalised recommendations