Francisco Campos-Rodriguez1, Miguel A Martínez-García2, Nuria Reyes-Nuñez3, Maria J Selma-Ferrer4, Naresh M Punjabi5, Ramon Farre6. 1. Respiratory Department, Hospital Universitario Valme, Sevilla, Spain. Electronic address: fracamrod@gmail.com. 2. Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. 3. Respiratory Department, Hospital Universitario Valme, Sevilla, Spain. 4. Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain. 5. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA. 6. Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Abstract
OBJECTIVE: To assess the impact of three hypopnea definitions on the severity classification of obstructive sleep apnea (OSA) and its association with cardiovascular mortality risk in women and elderly individuals. METHODS: We analyzed two Spanish clinical cohorts (1116 women and 939 elderly individuals) who were studied for suspicion of OSA between 1998 and 2007. A calibration model was used to apply different definitions of hypopnea to our two cohorts. Hypopnea was defined as a 30-90% reduction in oronasal flow for ≥10 s followed by (1) ≥4% fall in oxyhemoglobin saturation-AHI4%; (2) ≥3% fall in oxyhemoglobin saturation-AHI3%; or (3) ≥3% fall in oxyhemoglobin saturation or an event-related arousal-AHI3%a. RESULTS: In both cohorts, the prevalence of an AHI ≥30 events/h increased by 14% with AHI3%a, compared to AHI4% criteria. The percentage of women with an AHI <5 events/h decreased from 13.9% with AHI4% to 1.1% with the AHI3%a definition. In fully adjusted multivariable analyses, AHI ≥30 events/h was associated with increased cardiovascular mortality risk in women, regardless of the hypopnea definition, and in elderly individuals diagnosed using the AHI4% and AHI3% but not the AHI3%a definition. CONCLUSIONS: Our findings suggest that hypopnea definitions substantially influence OSA prevalence and severity classification, and also affect the association with cardiovascular outcomes. With the currently recommended criterion (AHI3%a), a threshold of 30 events/h is appropriate to identify women, but not elderly individuals with increased risk of cardiovascular death.
OBJECTIVE: To assess the impact of three hypopnea definitions on the severity classification of obstructive sleep apnea (OSA) and its association with cardiovascular mortality risk in women and elderly individuals. METHODS: We analyzed two Spanish clinical cohorts (1116 women and 939 elderly individuals) who were studied for suspicion of OSA between 1998 and 2007. A calibration model was used to apply different definitions of hypopnea to our two cohorts. Hypopnea was defined as a 30-90% reduction in oronasal flow for ≥10 s followed by (1) ≥4% fall in oxyhemoglobin saturation-AHI4%; (2) ≥3% fall in oxyhemoglobin saturation-AHI3%; or (3) ≥3% fall in oxyhemoglobin saturation or an event-related arousal-AHI3%a. RESULTS: In both cohorts, the prevalence of an AHI ≥30 events/h increased by 14% with AHI3%a, compared to AHI4% criteria. The percentage of women with an AHI <5 events/h decreased from 13.9% with AHI4% to 1.1% with the AHI3%a definition. In fully adjusted multivariable analyses, AHI ≥30 events/h was associated with increased cardiovascular mortality risk in women, regardless of the hypopnea definition, and in elderly individuals diagnosed using the AHI4% and AHI3% but not the AHI3%a definition. CONCLUSIONS: Our findings suggest that hypopnea definitions substantially influence OSA prevalence and severity classification, and also affect the association with cardiovascular outcomes. With the currently recommended criterion (AHI3%a), a threshold of 30 events/h is appropriate to identify women, but not elderly individuals with increased risk of cardiovascular death.
Authors: Risa Nakase-Richardson; Marie N Dahdah; Emily Almeida; Peter Ricketti; Marc A Silva; Karel Calero; Ulysses Magalang; Daniel J Schwartz Journal: J Clin Sleep Med Date: 2020-06-15 Impact factor: 4.062
Authors: Adeel Nazir Ahmad; Geraldine McLeod; Nada Al Zahrani; Haneen Al Zahrani Journal: Int J Environ Res Public Health Date: 2019-02-05 Impact factor: 3.390