STUDY OBJECTIVES: Determining the presence and severity of obstructive sleep apnea (OSA) is based on apnea and hypopnea event rates per hour of sleep. Making this determination presents a diagnostic challenge, given that summary metrics do not consider certain factors that influence severity, such as body position and the composition of sleep stages. METHODS: We retrospectively analyzed 300 consecutive diagnostic PSGs performed at our center to determine the impact of body position and sleep stage on sleep apnea severity. RESULTS: The median percent of REM sleep was 16% (reduced compared to a normal value of ~25%). The median percent supine sleep was 65%. Fewer than half of PSGs contained > 10 min in each of the 4 possible combinations of REM/NREM and supine/non-supine. Half of patients had > 2-fold worsening of the apnea-hypopnea index (AHI) in REM sleep, and 60% had > 2-fold worsening of AHI while supine. Adjusting for body position had greater impact on the AHI than adjusting for reduced REM%. Misclassification--specifically underestimation of OSA severity--is attributed more commonly to body position (20% to 40%) than to sleep stage (~10%). CONCLUSIONS: Supine-dominance and REM-dominance commonly contribute to AHI underestimation in single-night PSGs. Misclassification of OSA severity can be mitigated in a patient-specific manner by appropriate consideration of these variables. The results have implications for the interpretation of single-night measurements in clinical practice, especially with trends toward home testing devices that may not measure body position or sleep stage.
STUDY OBJECTIVES: Determining the presence and severity of obstructive sleep apnea (OSA) is based on apnea and hypopnea event rates per hour of sleep. Making this determination presents a diagnostic challenge, given that summary metrics do not consider certain factors that influence severity, such as body position and the composition of sleep stages. METHODS: We retrospectively analyzed 300 consecutive diagnostic PSGs performed at our center to determine the impact of body position and sleep stage on sleep apnea severity. RESULTS: The median percent of REM sleep was 16% (reduced compared to a normal value of ~25%). The median percent supine sleep was 65%. Fewer than half of PSGs contained > 10 min in each of the 4 possible combinations of REM/NREM and supine/non-supine. Half of patients had > 2-fold worsening of the apnea-hypopnea index (AHI) in REM sleep, and 60% had > 2-fold worsening of AHI while supine. Adjusting for body position had greater impact on the AHI than adjusting for reduced REM%. Misclassification--specifically underestimation of OSA severity--is attributed more commonly to body position (20% to 40%) than to sleep stage (~10%). CONCLUSIONS: Supine-dominance and REM-dominance commonly contribute to AHI underestimation in single-night PSGs. Misclassification of OSA severity can be mitigated in a patient-specific manner by appropriate consideration of these variables. The results have implications for the interpretation of single-night measurements in clinical practice, especially with trends toward home testing devices that may not measure body position or sleep stage.
Authors: Nancy A Collop; Sharon L Tracy; Vishesh Kapur; Reena Mehra; David Kuhlmann; Sam A Fleishman; Joseph M Ojile Journal: J Clin Sleep Med Date: 2011-10-15 Impact factor: 4.062
Authors: J Peter van Maanen; Wietske Richard; Ellen R Van Kesteren; Madeline J L Ravesloot; D Martin Laman; Antonius A J Hilgevoord; Nico de Vries Journal: J Sleep Res Date: 2011-10-22 Impact factor: 3.981
Authors: Raphael C Heinzer; Cyril Pellaton; Vincianne Rey; Andrea O Rossetti; Gianpaolo Lecciso; José Haba-Rubio; Mehdi Tafti; Gilles Lavigne Journal: Sleep Med Date: 2012-01-18 Impact factor: 3.492
Authors: Karin A Garcia; William K Wohlgemuth; Ele Ferrannini; Andrea Mari; Alex Gonzalez; Armando J Mendez; Roberto Bizzotto; Jay S Skyler; Neil Schneiderman; Barry E Hurwitz Journal: Physiol Behav Date: 2018-04-12
Authors: Marijke Dieltjens; Marc J Braem; Paul H Van de Heyning; Kristien Wouters; Olivier M Vanderveken Journal: J Clin Sleep Med Date: 2014-09-15 Impact factor: 4.062
Authors: Jolien Beyers; O M Vanderveken; C Kastoer; A Boudewyns; I De Volder; A Van Gastel; J A Verbraecken; W A De Backer; M J Braem; P H Van de Heyning; M Dieltjens Journal: Sleep Breath Date: 2019-02-18 Impact factor: 2.816