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Clinical, polysomnographic, and cephalometric features of obstructive sleep apnea with AHI over 100

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) is induced by a sleep-related collapse of the upper airway in association with multiple factors. The severity of OSA is determined by the apnea-hypopnea index (AHI). Although obesity and sex differences are common factors in OSA, the level of the AHI varies to the same degree according to the age and sex and degree of obesity. However, only a few studies have evaluated AHI over 100/h, those reports did not describe why they set the AHI cutoff at 100/h. The purpose of this study was to elucidate the pathogenesis of “very” severe OSA, defined as having an AHI > 100/h.

Methods

AHI > 100/h was set as very severe OSA (VS-OSA) in this study. As controls, moderate to severe OSA patients, matched with VS-OSA for age, sex, and body mass index (BMI), were enrolled. The findings of polysomnography and cephalography between VS-OSA and controls were compared.

Results

Eleven patients in the VS-OSA group (mean AHI 110.2/h) and 22 patients in the control group (mean AHI 41.6/h) were compared (mean age 50.2 vs 50.6, male:female 5:6 vs 10:12, mean BMI 35.4 kg/m2 vs 34.5 kg/m2). There were no significant differences in the clinical characteristics. In the polysomnographic parameters, the VS-OSA group showed apnea predominance, the mean percutaneous oxygen saturation (SO2) was significantly lower in all sleep stages, and the minimum SO2 was significantly lower (49.0% vs 77.5%, p = 0.002). A similar apnea duration and rather shorter hypopnea duration were shown. The time of apnea-to-arousal was significantly earlier (− 0.1 s vs 0.9 s, p = 0.003). Lung-to-finger circulation time showed no differences. The cephalometric findings showed no significant differences.

Conclusions

VS-OSA patients were more likely to have apnea predominance, desaturation when sleeping despite a similar apnea duration, and rather shorter hypopnea duration, and arousals were evoked significantly earlier.

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Author information

Authors and Affiliations

  1. Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan

    Naoko Sata, Ayako Inoshita, Shoko Suda, Satomi Shiota, Yo Suzuki & Takatoshi Kasai

  2. Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan

    Naoko Sata, Ayako Inoshita, Yo Suzuki, Fumihiko Matsumoto & Katsuhisa Ikeda

  3. Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan

    Shoko Suda & Takatoshi Kasai

  4. Department of Respiratory Medicine, Juntendo University Hospital, Tokyo, Japan

    Satomi Shiota

  5. Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Nanako Shiroshita, Fusae Kawana & Takatoshi Kasai

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  1. Naoko Sata
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Contributions

N.S. and A.I.: Designed and performed experiments, analyzed data, and co-wrote the paper. S. Suda: Performed lung-to-finger circulation time analyses. S. Shiota: Performed respiratory function analyses. N.S. and F.K.: Performed polysomnographic analyses. Y.S. and F.M.: Performed cepharogaphic analyses. K.I.: Supervised the research. T.K.: Supervised the research and co-write the paper. All authors contributed to the writing of the final manuscript.

Corresponding author

Correspondence to Ayako Inoshita.

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Conflict of interest/

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Since, in the present study, the sleep study, anthropometric data collection and cephalometric data had already been obtained and analyzed as in a routine clinical checkup, the requirement to obtain informed consent was waived by the ethics committee of Juntendo University Hospital using opt-out methods (#19-273).

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Not applicable.

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The datasets generated during and/or analyzed during the current study available from the corresponding author on reasonable request.

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Sata, N., Inoshita, A., Suda, S. et al. Clinical, polysomnographic, and cephalometric features of obstructive sleep apnea with AHI over 100. Sleep Breath 25, 1379–1387 (2021). https://doi.org/10.1007/s11325-020-02241-8

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  • DOI: https://doi.org/10.1007/s11325-020-02241-8

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