Skip to main content

Advertisement

SpringerLink
Log in

Effect of oxygen desaturation threshold on determination of OSA severity during weight loss

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Weight loss leads to improvement of obstructive sleep apnea (OSA), based on frequency of respiratory events (apnea-hypopnea index, AHI). However, AHI does not incorporate the severity of individual obstruction events. The American Academy of Sleep Medicine suggests two alternative oxygen desaturation thresholds (ODT) for scoring of hypopneas. We hypothesize that lowering the ODT level increases the determined impact of weight loss on OSA severity. We investigate this during weight change with AHI and adjusted AHI. Adjusted AHI is a novel parameter incorporating both severity and number of the events.

Methods

Ambulatory polygraphic data of 54 OSA patients (F 15/M 39, 51.7 ± 8.4 years), divided into weight loss (>5 %, n = 20), control (weight change 0–5 %, n = 26), and weight gain (>5 %, n = 8) groups, were evaluated at baseline and after 5-year follow-up. Effect of ODT (ODT2%–ODT6%) on AHI and adjusted AHI was investigated.

Results

The greatest changes in AHI (decrease in weight loss group and increase in weight gain group) were observed with ODT2%. Changes in AHI diminished with increasing ODT. In weight loss group, adjusted AHI showed a similar but non-significant trend. In contrast, the higher ODT was used in weight gain group, the greater increase in adjusted AHI resulted. Using adjusted AHI instead of AHI, led to a smaller number of patients (20 vs. 55 %, ODT3%) whose OSA severity category improved along weight loss.

Conclusions

Weight loss significantly reduced AHI. This reduction was highly dependent on selected ODT. The change in adjusted AHI did not occur in the same extent. This was expected as the more severe events which tend to remain during the weight loss have greater importance in adjusted AHI, while the event severity is neglected in AHI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021

    Article  CAS  PubMed  Google Scholar 

  2. Wolk R, Shamsuzzaman AS, Somers VK (2003) Obesity, sleep apnea, and hypertension. Hypertension 42:1067–1074

    Article  CAS  PubMed  Google Scholar 

  3. Young T, Skatrud J, Peppard PE (2004) Risk factors for obstructive sleep apnea in adults. JAMA 291:2013–2016

    Article  CAS  PubMed  Google Scholar 

  4. Strobel RJ, Rosen RC (1996) Obesity and weight loss in obstructive sleep apnea: a critical review. Sleep 19:104–115

    CAS  PubMed  Google Scholar 

  5. Vgontzas AN (2008) Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem 114:211–223

    Article  CAS  PubMed  Google Scholar 

  6. Foster GD, Borradaile KE, Sanders MH, Sleep AHEAD Research Group of Look AHEAD Research Group et al (2009) A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med 169:1619–1626

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tuomilehto H, Seppa J, Uusitupa M (2013) Obesity and obstructive sleep apnea—clinical significance of weight loss. Sleep Med Rev 17:321–329

    Article  PubMed  Google Scholar 

  8. Pillar G, Shehadeh N (2008) Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care 31(Suppl 2):S303–S309

    Article  PubMed  Google Scholar 

  9. 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 

  10. 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 

  11. 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  PubMed Central  Google Scholar 

  12. 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 5 May 2014

  13. 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 

  14. Mehra R, Benjamin EJ, Shahar E et al (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: the sleep heart health study. Am J Respir Crit Care Med 173:910–916

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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  PubMed Central  Google Scholar 

  16. 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 18:767–773

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  18. Shahar E (2014) Apnea-hypopnea index: time to wake up. Nat Sci Sleep 6:51–56

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tam S, Woodson BT, Rotenberg B (2014) Outcome measurements in obstructive sleep apnea: beyond the apnea-hypopnea index. Laryngoscope 124:337–343

    Article  PubMed  Google Scholar 

  20. 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 

  21. 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 

  22. 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 

  23. Berger G, Berger R, Oksenberg A (2009) Progression of snoring and obstructive sleep apnoea: the role of increasing weight and time. Eur Respir J 33:338–345

    Article  CAS  PubMed  Google Scholar 

  24. Johansson K, Neovius M, Lagerros YT et al (2009) Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial. BMJ 339:b4609

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tuomilehto HP, Seppa JM, Partinen MM, Kuopio Sleep Apnea Group et al (2009) Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179:320–327

    Article  PubMed  Google Scholar 

  26. Tuomilehto H, Gylling H, Peltonen M, Kuopio Sleep Apnea Group et al (2010) Sustained improvement in mild obstructive sleep apnea after a diet- and physical activity-based lifestyle intervention: postinterventional follow-up. Am J Clin Nutr 92:688–696

    Article  CAS  PubMed  Google Scholar 

  27. Kuna ST, Reboussin DM, Borradaile KE, Sleep AHEAD Research Group of the Look AHEAD Research Group et al (2013) Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 36:641–649A

    PubMed  PubMed Central  Google Scholar 

  28. 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 

  29. Kulkas A, Leppänen T, Sahlman J et al (2014) Weight loss alters severity of individual nocturnal respiratory events depending on sleeping position. Physiol Meas 35:2037–2052

    Article  CAS  PubMed  Google Scholar 

  30. 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 

  31. Tuomilehto H, Seppä J, Uusitupa M, Tuomilehto J, Gylling H (2013) Weight reduction and increased physical activity to prevent the progression of obstructive sleep apnea: a 4-year observational postintervention follow-up of a randomized clinical trial. JAMA Intern Med 173:930–932

    Article  Google Scholar 

  32. Tuomilehto H, Seppä J, Uusitupa M, Kuopio Sleep Apnea Group et al (2014) The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial. Sleep Med 15:329–335

    Article  PubMed  Google Scholar 

  33. Punjabi NM, Caffo BS, Goodwin JL et al (2009) Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 6:e1000132

    Article  PubMed  PubMed Central  Google Scholar 

  34. Peppard PE, Ward NR, Morrell MJ (2009) The impact of obesity on oxygen desaturation during sleep-disordered breathing. Am J Respir Crit Care Med 180:788–793

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sato M, Suzuki M, Suzuki J et al (2008) Overweight patients with severe sleep apnea experience deeper oxygen desaturation at apneic events. J Med Dent Sci 55:43–47

    PubMed  Google Scholar 

  36. Collop NA, 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. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3:737–747

    PubMed  Google Scholar 

Download references

Acknowledgments

This study work was financially supported by grants from the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (Projects 5041732, 5041733, and 5041748) and Seinäjoki Central Hospital, the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital (Grant Numbers VTR3040 and VTR3114). One author (KM) is supported by the Finnish Cultural Foundation of Northern Savo and the Finnish Brain Foundation.

Author information

Author notes

    Authors and Affiliations

    1. Department of Clinical Neurophysiology, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland

      Katja Myllymaa, Sami Myllymaa, Timo Leppänen, Salla Kupari, Pekka Tiihonen, Esa Mervaala & Juha Töyräs

    2. Department of Applied Physics, University of Eastern Finland, Kuopio, Finland

      Sami Myllymaa, Timo Leppänen & Juha Töyräs

    3. Institute of Dentistry, University of Eastern Finland, Kuopio, Finland

      Sami Myllymaa

    4. Department of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland

      Antti Kulkas

    5. Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland

      Salla Kupari, Esa Mervaala & Juha Seppä

    6. Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland

      Juha Seppä

    7. Oivauni Sleep Clinic, Kuopio, Finland

      Henri Tuomilehto

    8. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland

      Henri Tuomilehto

    Authors
    1. Katja Myllymaa
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Sami Myllymaa
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Timo Leppänen
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Antti Kulkas
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Salla Kupari
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Pekka Tiihonen
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Esa Mervaala
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Juha Seppä
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Henri Tuomilehto
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Juha Töyräs
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Sami Myllymaa.

    Additional information

    Katja Myllymaa and Sami Myllymaa contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Myllymaa, K., Myllymaa, S., Leppänen, T. et al. Effect of oxygen desaturation threshold on determination of OSA severity during weight loss. Sleep Breath 20, 33–42 (2016). https://doi.org/10.1007/s11325-015-1180-4

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11325-015-1180-4

    Keywords

    Search

    Navigation