Chest
Clinical InvestigationsSleep and BreathingImpact of Different Criteria for Defining Hypopneas in the Apnea-Hypopnea Index
Section snippets
Materials and Methods
Forty-eight diagnostic sleep study records were retrospectively selected at random from a sleep study database. This database included all sleep studies performed on patients at a tertiary sleep center during a 6-month period. The random-number sequence was computer generated. A large proportion of subjects in the database had AHI scores at the lower end of the spectrum. In order to improve resolution near the threshold of interest, random selection of sleep study records was stratified
Results
There were a total of 48 patient records included in the analysis. Only one patient record was excluded due to poor quality signals, and this was replaced by another randomly selected patient record. Of the patients included in the study, 92% were men (mean age, 52 years; range, 20 to 86 years). The mean body mass index was 32 kg/m2 (range, 24 to 42 kg/m2).
Discussion
This study has compared three different methods of scoring hypopneas that represent the extremes of criteria set in Victoria for analyzing polysomnographic results. Overall, our findings indicate that the method used for scoring hypopneas may influence both the diagnosis of sleep apnea and the rating of disease severity. The limits of agreement presented suggest that AHIs derived from different scoring methods for hypopneas differ to a clinically relevant extent. For example, method A may give
Conclusion
The absolute level of agreement between AHIs derived from some of the different scoring methods used in current clinical practice was poor. However, the different scoring methods tended to rank patients reasonably consistently; for a large proportion of patients, the scoring method may be irrelevant. When different thresholds of AHI used in practice are applied, however, the inconsistency in classification becomes more apparent. These findings have implications for case finding, population
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Cited by (50)
Current hypopnea scoring criteria underscore pediatric sleep disordered breathing
2011, Sleep MedicineCitation Excerpt :Disagreement regarding the definition of an hypopnea, the duration of an electroencephalogram (EEG) arousal, the degree of airflow reduction, and the percentage of oxygen desaturation has been reported [4–8]. The use of different scoring criteria has led to significant variability in the AHI [6–10], subsequently affecting the interpretation of disease severity, the treatment plan for individual patients, and the estimation of prevalence and morbidity for epidemiological purposes. The 2007 AASM scoring criteria [11], emphasizing an old rule for scoring “hypopneas” and adding the “respiratory event related arousal” component without any well defined criteria for scoring these events, have not resolved this issue.
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The study was funded by the Victorian Department of Human Services.
This study was performed at the Austin and Repatriation Medical Center, Heidelberg, Victoria, Australia.