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Sleepiness in obstructive sleep apnea using hypopneas defined by a 3% oxygen desaturation or arousal but not by 4% or greater oxygen desaturation

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Study objectives

This analysis determined the association between obstructive sleep apnea (OSA) with hypopneas defined by a 3% O2 desaturation or arousal (3%A), but not by a hypopnea criterion of ≥ 4% (4%), and subjective sleepiness.

Methods

Data were analyzed from Sleep Heart Health Study participants who had polysomnography (N = 6307) regarding OSA and subjective sleepiness scores (Epworth Sleepiness Scale, ESS). The apnea hypopnea index (AHI) was classified based on 3% only, 3%A only, and 4% definitions of hypopneas.

Results

Of the 3326 participants without 4% OSA, 67.6% (n = 2247) had 3%A only OSA. The ESS score was higher in 3%A only OSA than in those without OSA (7.44 ± 4.2 vs 7.07 ± 4.3, P = 0.02). Of those without 4% OSA, 40.2% (n = 1336) had 3% only OSA. The ESS score was higher in those with 3% only OSA than those with no OSA (7.72 ± 4.3 vs 7.05 ± 4.2, P < 0.001). A linear regression model demonstrated a trend towards significance for the 3%A only AHI as an independent predictor of ESS when controlled for age, BMI, and sex (P = 0.051). The association of 3% only AHI with the ESS was stronger (P = 0.003). However, 23.3% of the participants with hypersomnia would not qualify as having OSA if arousals were excluded from the definition of OSA.

Conclusion

The current study found that the presence and severity of OSA is associated with higher ESS scores in persons with 3%A only OSA. Hence, the use of the 4% hypopnea definition will result in the failure to identify and treat a significant number of individuals with OSA who have subjective sleepiness.

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Acknowledgements

The Sleep Heart Health Study was supported by National Heart, Lung and Blood Institute cooperative agreements U01HL53940 (University of Washington), U01HL53941 (Boston University), U01HL53938 (University of Arizona), U01HL53916 (University of California, Davis), U01HL53934 (University of Minnesota), U01HL53931 (New York University), U01HL53937 and U01HL64360 (Johns Hopkins University), U01HL63463 (Case Western Reserve University), and U01HL63429 (Missouri Breaks Research). A list of SHHS investigators, staff and their participating institutions is available on the SHHS website, http://jhuccs1.us/shhs/details/investigators.htm.

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Authors and Affiliations

  1. Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA

    Rohit Budhiraja & Stuart F. Quan

  2. Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA

    Stuart F. Quan

Authors
  1. Rohit Budhiraja
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  2. Stuart F. Quan
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All authors have read and approve this manuscript.

Corresponding author

Correspondence to Rohit Budhiraja.

Ethics declarations

Informed consent

SHHS was approved by the respective institutional review boards for human subjects research at each site, and informed written consent was obtained from all subjects at the time of their enrollment into each stage of the study.

Research involving human participants and/or animals

The current study involved analysis of publicly available data from Sleep Heart Health Study (SHHS). All procedures performed in SHHS 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

Dr. Budhiraja reports no conflicts of interest or grant funding. Dr. Quan reports research funding from the National Institutes of Health, serves as a consultant to Jazz Pharmaceuticals and Whispersom, and is a committee chair and hypopnea taskforce member for the American Academy of Sleep Medicine.

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Budhiraja, R., Quan, S.F. Sleepiness in obstructive sleep apnea using hypopneas defined by a 3% oxygen desaturation or arousal but not by 4% or greater oxygen desaturation. Sleep Breath 26, 1135–1139 (2022). https://doi.org/10.1007/s11325-021-02494-x

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  • DOI: https://doi.org/10.1007/s11325-021-02494-x

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