RATIONALE: Epidemiologic studies on the consequences of sleep-disordered breathing invariably use the apnea-hypopnea index as the primary measure of disease severity. Although hypopneas constitute a majority of disordered breathing events, significant controversy remains about the best criteria used to define these events. OBJECTIVES: The current investigation sought to assess the most appropriate definition for hypopneas that would be best correlated with cardiovascular disease. METHODS: A community sample of middle-aged and older adults was recruited as part of the Sleep Heart Health Study. Full-montage polysomnography was conducted and hypopneas were defined using different thresholds of oxyhemoglobin desaturation with and without arousals. Prevalent cardiovascular disease was assessed based on self-report. Logistic regression analysis was used to characterize the independent association between the hypopnea index and prevalent cardiovascular disease. MEASUREMENTS AND MAIN RESULTS: Using a sample of 6,106 adults with complete data on cardiovascular disease status and polysomnography, the current study found that hypopneas associated with an oxyhemoglobin desaturation of 4% or more were associated with prevalent cardiovascular disease independent of confounding covariates. The adjusted prevalent odds ratios for quartiles of the hypopnea index using a 4% desaturation criterion were as follows: 1.00 (<1.10 events/h), 1.10 (1.01-3.20 events/h), 1.33 (3.21-7.69 events/h), and 1.41 (>7.69 events/h). Hypopnea measures based on less than 4% oxyhemoglobin desaturation or presence of arousals showed no association with cardiovascular disease. CONCLUSIONS: Hypopneas comprise a significant component of sleep-disordered breathing in the general community. By varying the criteria for defining hypopneas, this study demonstrates that hypopneas with a desaturation of at least 4% are independently associated with cardiovascular disease. In contrast, no association was observed between cardiovascular disease and hypopneas associated with milder desaturations or arousals.
RATIONALE: Epidemiologic studies on the consequences of sleep-disordered breathing invariably use the apnea-hypopnea index as the primary measure of disease severity. Although hypopneas constitute a majority of disordered breathing events, significant controversy remains about the best criteria used to define these events. OBJECTIVES: The current investigation sought to assess the most appropriate definition for hypopneas that would be best correlated with cardiovascular disease. METHODS: A community sample of middle-aged and older adults was recruited as part of the Sleep Heart Health Study. Full-montage polysomnography was conducted and hypopneas were defined using different thresholds of oxyhemoglobin desaturation with and without arousals. Prevalent cardiovascular disease was assessed based on self-report. Logistic regression analysis was used to characterize the independent association between the hypopnea index and prevalent cardiovascular disease. MEASUREMENTS AND MAIN RESULTS: Using a sample of 6,106 adults with complete data on cardiovascular disease status and polysomnography, the current study found that hypopneas associated with an oxyhemoglobin desaturation of 4% or more were associated with prevalent cardiovascular disease independent of confounding covariates. The adjusted prevalent odds ratios for quartiles of the hypopnea index using a 4% desaturation criterion were as follows: 1.00 (<1.10 events/h), 1.10 (1.01-3.20 events/h), 1.33 (3.21-7.69 events/h), and 1.41 (>7.69 events/h). Hypopnea measures based on less than 4% oxyhemoglobin desaturation or presence of arousals showed no association with cardiovascular disease. CONCLUSIONS:Hypopneas comprise a significant component of sleep-disordered breathing in the general community. By varying the criteria for defining hypopneas, this study demonstrates that hypopneas with a desaturation of at least 4% are independently associated with cardiovascular disease. In contrast, no association was observed between cardiovascular disease and hypopneas associated with milder desaturations or arousals.
Authors: C W Whitney; D J Gottlieb; S Redline; R G Norman; R R Dodge; E Shahar; S Surovec; F J Nieto Journal: Sleep Date: 1998-11-01 Impact factor: 5.849
Authors: S Redline; M H Sanders; B K Lind; S F Quan; C Iber; D J Gottlieb; W H Bonekat; D M Rapoport; P L Smith; J P Kiley Journal: Sleep Date: 1998-11-01 Impact factor: 5.849
Authors: E Shahar; C W Whitney; S Redline; E T Lee; A B Newman; F J Nieto; G T O'Connor; L L Boland; J E Schwartz; J M Samet Journal: Am J Respir Crit Care Med Date: 2001-01 Impact factor: 21.405
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Authors: B M Psaty; L H Kuller; D Bild; G L Burke; S J Kittner; M Mittelmark; T R Price; P M Rautaharju; J Robbins Journal: Ann Epidemiol Date: 1995-07 Impact factor: 3.797
Authors: Susan Redline; Rohit Budhiraja; Vishesh Kapur; Carole L Marcus; Jason H Mateika; Reena Mehra; Sariam Parthasarthy; Virend K Somers; Kingman P Strohl; Loreto G Sulit; David Gozal; Merrill S Wise; Stuart F Quan Journal: J Clin Sleep Med Date: 2007-03-15 Impact factor: 4.062
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Authors: Neil R Ward; Vitor Roldao; Martin R Cowie; Stuart D Rosen; Theresa A McDonagh; Anita K Simonds; Mary J Morrell Journal: Sleep Date: 2013-09-01 Impact factor: 5.849
Authors: A Roebuck; V Monasterio; E Gederi; M Osipov; J Behar; A Malhotra; T Penzel; G D Clifford Journal: Physiol Meas Date: 2013-12-17 Impact factor: 2.833
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