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Comparison of hypopnea definitions in lean patients with known obstructive sleep apnea hypopnea syndrome (OSAHS)

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Abstract

Study objectives

In the interest of improving inter-rater reliability and standardization between sleep laboratories, hypopnea definitions were recently changed to place less emphasis on arousal scoring and more emphasis on oxygen desaturations. We sought to determine whether these changes would affect detection and treatment of OSAHS in lean patients—a group known to desaturate less-than-obese patients.

Methods

Thirty-five lean subjects (15 male, 20 women, five post-menopausal) diagnosed OSAHS and a documented benefit from treatment had diagnostic polysomnograms (PSG) originally scored using the American Academy of Sleep Medicine (AASM) rule from 1999 (referred to as “Rule C”). These patients had appropriate clinical care based on those results. PSG records were then re-scored in a randomized and blinded fashion utilizing hypopnea Rule A and B of the 2007 AASM guidelines.

Results

Baseline mean (SD) apnea hypopnea indices (AHI) for rules A, B, and C were 6.4 (3.1), 20.6 (8.2), and 26.9 (7.3), respectively (p < 0.0001). Mean (SD) BMI was 24.4 (1.0). By design, all subjects were treatment responders. Eighty-six percent with CPAP, 83% with oral appliance, and 100% with surgical intervention reported resolution of their initial daytime or sleep complaint. Post-treatment AHIs for rules A, B, and C were 0.8 (0.9), 1.8 (1.2) and 2.3 (1.6; p < 0.001). In all three scoring conditions, the AHI was reduced significantly with treatment (p < 0.001). A repeated measures ANOVA of the difference between scoring methods indicated statistically significant differences between all three strategies at both pre- and post-treatment (p < 0.001). Sleepiness on the Epworth sleepiness scale decreased from a mean of 10.9 (2.3) to 5.7 (1.3) with treatment (p < 0.001). This change in subjective rating of sleepiness was more strongly correlated with rules B and C (r = 0.6) and more modestly correlated with Rule A scoring (r = 0.4).

Conclusion

Response to treatment was more tightly correlated with arousal based scoring rules B and C in this group of lean subjects. The1999 hypopnea rule was used at baseline to detect this cohort of patients with OSAHS that ultimately benefitted from treatment. Rule B detected OSAHS and correlated well with response to treatment, but many more were categorized as mild (5 < AHI < 15) at baseline. Since 40% of the subjects had an AHI less than 5 with Rule A, lack of sensitivity should be considered before applying Rule A to the scoring of sleep studies in lean patients.

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References

  1. Bickelmann AG, Burwell CS, Robin ED et al (1956) Extreme obesity associated with alveolar hypoventilation; a Pickwickian syndrome. Am J Med 21(5):811–818. doi:10.1016/0002-9343(56)90094-8

    Article  CAS  PubMed  Google Scholar 

  2. Guilleminault C, Tilkian A, Dement WC (1976) The sleep apnea syndromes. Annu Rev Med 27:465–484. doi:10.1146/annurev.me.27.020176.002341

    Article  CAS  PubMed  Google Scholar 

  3. Gould GA, Whyte KF, Rhind GB et al (1988) The sleep hypopnea syndrome. Am Rev Respir Dis 137(4):895–898

    CAS  PubMed  Google Scholar 

  4. Redline S, Budhiraja R, Kapur V et al (2007) The scoring of respiratory events in sleep: reliability and validity. J Clin Sleep Med 3(2):169–200

    PubMed  Google Scholar 

  5. Raj R, Hirshkowitz M (2003) Effect of the new Medicare guideline on patient qualification for positive airway pressure therapy. Sleep Med 4(1):29–33. doi:10.1016/s1389-9457(02)00150-8

    Article  PubMed  Google Scholar 

  6. Iber C, Ancoli-Israel S, Chesson A, Quan SF (eds) (2007) The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, Illinois: American Academy of Sleep Medicine

  7. Douglass AB, Bornstein R, Nino-Murcia G et al (1994) The Sleep Disorders Questionnaire. I: Creation and multivariate structure of SDQ. Sleep 17(2):160–167

    CAS  PubMed  Google Scholar 

  8. Rechtschaffen AKA (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects: US Department of Health, Education and Welfare Public Health Service—NIH/NIND

  9. The Report of an American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689

    Google Scholar 

  10. Ciftci TU, Kokturk O, Ozkan S (2004) Apnea–hypopnea indexes calculated using different hypopnea definitions and their relation to major symptoms. Sleep Breath 8(3):141–146. doi:10.1055/s-2004-834484

    Article  PubMed  Google Scholar 

  11. Redline S, Sanders M (1997) Hypopnea, a floating metric: implications for prevalence, morbidity estimates, and case finding. Sleep 20(12):1209–1217

    CAS  PubMed  Google Scholar 

  12. Bonnet MH (1986) Performance and sleepiness as a function of frequency and placement of sleep disruption. Psychophysiology 23:3. doi:10.1111/j.1469-8986.1986.tb00630.x

    Article  Google Scholar 

  13. Wesensten NJ, Balkin TJ, Belenky G (1999) Does sleep fragmentation impact recuperation? A review and reanalysis. J Sleep Res 8(4):237–245. doi:10.1046/j.1365-2869.1999.00161.x See comment

    Article  CAS  PubMed  Google Scholar 

  14. Thomas RJ (2006) Sleep fragmentation and arousals from sleep-time scales, associations, and implications. Clin Neurophysiol 117(4):707–711. doi:10.1016/j.clinph.2005.12.014

    Article  PubMed  Google Scholar 

  15. Boyd JH, Petrof BJ, Hamid Q et al (2004) Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. Am J Respir Crit Care Med 170(5):541–546. doi:10.1164/rccm.200308-1100OC

    Article  PubMed  Google Scholar 

  16. Edstrom L, Larsson H, Larsson L (1992) Neurogenic effects on the palatopharyngeal muscle in patients with obstructive sleep apnoea: a muscle biopsy study. J Neurol Neurosurg Psychiatry 55(10):916–920. doi:10.1136/jnnp.55.10.916

    Article  CAS  PubMed  Google Scholar 

  17. Friberg D, Ansved T, Borg K et al (1998) Histological indications of a progressive snorers disease in an upper airway muscle. Am J Respir Crit Care Med 157(2):586–593

    CAS  PubMed  Google Scholar 

  18. Friberg D, Gazelius B (1998) Evaluation of the vascular reaction in pharyngeal mucosa. Acta Otolaryngol 118(3):413–418. doi:10.1080/00016489850183539

    Article  CAS  PubMed  Google Scholar 

  19. Friberg D, Gazelius B, Hokfelt T et al (1997) Abnormal afferent nerve endings in the soft palatal mucosa of sleep apnoics and habitual snorers. Regul Pept 71(1):29–36. doi:10.1016/S0167-0115(97)01016-1

    Article  CAS  PubMed  Google Scholar 

  20. Friberg D, Gazelius B, Lindblad LE et al (1998) Habitual snorers and sleep apnoics have abnormal vascular reactions of the soft palatal mucosa on afferent nerve stimulation. Laryngoscope 108(3):431–436. doi:10.1097/00005537-199803000-00022

    Article  CAS  PubMed  Google Scholar 

  21. Woodson BT, Garancis JC, Toohill RJ (1991) Histopathologic changes in snoring and obstructive sleep apnea syndrome. Laryngoscope 101(12 Pt 1):1318–1322

    Article  CAS  PubMed  Google Scholar 

  22. Kakkar RK, Berry RB (2007) Positive airway pressure treatment for obstructive sleep apnea. Chest 132(3):1057–1072. doi:10.1378/chest.06-2432

    Article  PubMed  Google Scholar 

  23. Meurice JC, Paquereau J, Denjean A et al (1998) Influence of correction of flow limitation on continuous positive airway pressure efficiency in sleep apnoea/hypopnoea syndrome. Eur Respir J 11(5):1121–1127. doi:10.1183/09031936.98.11051121

    Article  CAS  PubMed  Google Scholar 

  24. Thomas RJ (2007) Cyclic alternating pattern in the electroencephalogram: what is its clinical utility? Sleep 30(5):553–555 Comment

    PubMed  Google Scholar 

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There was no financial support for this work. The authors claim no conflict of interest.

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Correspondence to C. C. Hagen.

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Guilleminault, C., Hagen, C.C. & Huynh, N.T. Comparison of hypopnea definitions in lean patients with known obstructive sleep apnea hypopnea syndrome (OSAHS). Sleep Breath 13, 341–347 (2009). https://doi.org/10.1007/s11325-009-0253-7

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  • DOI: https://doi.org/10.1007/s11325-009-0253-7

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