A comparison between the AASM 2012 and 2007 definitions for detecting hypopnea

BaHammam, Ahmed S.; Obeidat, Amr M.; Barataman, Kashmira; Bahammam, Salman A.; Olaish, Awad H; Sharif, Munir M.

doi:10.1007/s11325-014-0939-3

Cited by 67 publications

(53 citation statements)

References 19 publications

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“…PSG analysis is a crucial for OSA diagnosis, and the ASSM scoring criteria have modified in 2012 for hypopnea, which is one of the most crucial PSG parameters. Previously, it has been reported that implementing the modified hypopnea criteria ( AASM 2012Rec ) may impact the general incidence of OSA . However, the effect of different scoring criteria on treatment outcome has not been identified.…”

Section: Discussionmentioning

confidence: 99%

“…Taken together, the new scoring rules for hypopnea tend to apply more sensitive criteria for diagnosing OSA. It is worth mentioning that such a trend might lead to include more cases for treatment . However, this is not necessarily perceived as negative.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown, however, that the AHI is poorly correlated with patients’ subjective symptoms and other metrics of disease burden . AHI can differ according to different scoring criterias . Therefore, using AHI as an index for assessing the therapeutic effect of surgery may have some limitations.…”

Section: Discussionmentioning

confidence: 99%

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Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

et al. 2019

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Objectives To assess the impact of the American Academy of Sleep Medicine (AASM) 2012Rec criteria on the surgical success rate and polysomnography (PSG) parameters of patients with obstructive sleep apnea (OSA). Study Design A prospective clinical trial. Methods A total of 60 patients who performed surgery for treatment of OSA at the sleep breathing disorder center of a tertiary referral university hospital from October 1, 2015, to September 30, 2016, were enrolled. Preoperative and postoperative PSG were performed and scored using AASM 2007Rec and AASM 2012Rec. Surgical success was determined by criteria 1 (postoperative Apnea‐Hypopnea Index [AHI] <20% and 50% reduction) and criteria 2 (postoperative AHI <10), and surgical success rates according to AASM 2007Rec and AASM 2012Rec were compared. Results PSG parameters including AHI, hypopnea index, respiratory effort‐related arousals, respiratory disturbance index, and supine AHI scored significantly higher with AASM 2012Rec compared to AASM 2007Rec criteria, both preoperatively and postoperatively (all P < 0.05). Furthermore, when compared to the AASM 2007Rec criteria, AASM 2012Rec resulted in increased proportion of patients with severe OSA (70.0% vs. 95.0%; P < 0.001). For the surgical outcomes, AASM 2012Rec showed significantly lower surgical success rate both in criteria 1 (51.7% vs. 38.3%) and criteria 2 (35.0% vs. 18.3%) compared to the AASM 2007Rec, respectively (P < 0 .05). Conclusions This study demonstrated that AASM 2012Rec tends to decrease the success rate of surgical outcome for OSA patients, suggesting that defining success of surgical treatment for OSA could be changed dramatically according to the hypopnea scoring criteria. Level of Evidence 4 Laryngoscope, 130:825–831, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

et al. 2019

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“…In this population, approximately one fifth of the sample have solely hypopneas with a greater than 50 % reduction in airflow, while the majority of the sample is evenly distributed with individuals that have hypopneas both above and below 50 % ( Fig. 1; also see the original article Figure 2-C [4]). This raises the question of whether changing percent reduction in airflow to define hypopneas obscures information important to an individuals' ventilatory capacity.…”

mentioning

confidence: 90%

“…The recent study by Dr. BaHamman and colleagues, examines the impact of altering the hypopnea definition on the indices of sleep breathing [4] as described for previous updates to scoring consensus [5]. In the current manuscript, the authors examine how changing the requisite percentage for reduction in airflow, and threshold level for oxygen desaturation and association with arousal, alters the distribution and significance of the clinical thresholds for disease.…”

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confidence: 99%

Hypopnea: ‘rule of thumb’ or ruler and plumb?

Kirkness

2014

Sleep Breath

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The need to establish clinically meaningful indices of sleep disorders are driven by the necessity for equity in access to healthcare resources and clinical treatment as well as the desire to understand the relationship between pathological markers, pervasive symptoms and comorbid consequences of disease. The controversy that surrounds the definition of hypopnea springs from a contrast between symptomatology and clinical significance that may not be fully captured by current metrics required by payers for reimbursement of treatment [1,2]. Sleep apnea clinical thresholds defining disease, treatment recommendations, and prevalence estimates are heavily influenced by hypopneas since obstructive apneas contribute only an estimated 5 to 25 % of the spectrum of sleep disordered breathing [3]. Inclusion of hypopneas in the indices of disease spectrum is intended to reflect ventilatory insufficiency by defining periods of reduced respiration. Developing more accurate measurements of inspired and expired airflow, and then providing more precise definitions for hypopneas, will be paramount for determining how mild, moderate and severe ventilation insufficiency are associated with clinically identifiable consequences such as magnitude of oxygen desaturation or duration of arousal from sleep.The recent study by Dr. BaHamman and colleagues, examines the impact of altering the hypopnea definition on the indices of sleep breathing [4] as described for previous updates to scoring consensus [5]. In the current manuscript, the authors examine how changing the requisite percentage for reduction in airflow, and threshold level for oxygen desaturation and association with arousal, alters the distribution and significance of the clinical thresholds for disease. Agreement between the AASM 2012 [1] and 2007 (recommended and alternate) [2] scoring guidelines were assessed using Bland Altman plots that display the difference between two scores plotted versus their average. Comparing criteria of a 50 % (2007) versus 30 % (2012) reduction in airflow both with 3 % desaturation or arousal, demonstrates approximately 10 events per hour less, are detected when the threshold for reduced airflow is decreased by 20 %. In this population, approximately one fifth of the sample have solely hypopneas with a greater than 50 % reduction in airflow, while the majority of the sample is evenly distributed with individuals that have hypopneas both above and below 50 % ( Fig. 1; also see the original article Figure 2-C [4]). This raises the question of whether changing percent reduction in airflow to define hypopneas obscures information important to an individuals' ventilatory capacity. On the one hand, a greater reduction in airflow may reflect a greater degree of airflow obstruction [6]; however, on the other hand may reflect increased ventilatory reserve [7] or lower arousal threshold [8].The analysis of BaHamman et. al. demonstrates systematic bias of agreement by applying comparisons of the indices of 30 % reduction in airflow for events classified wi...

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Evidence of neurodegeneration in obstructive sleep apnea: Relationship between obstructive sleep apnea and cognitive dysfunction in the elderly

Daulatzai

2015

J of Neuroscience Research

171

133

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The incidence of dementia and obstructive sleep apnea (OSA) increases with age. Late-onset Alzheimer's disease (AD) is an irreversible neurodegenerative disease of the elderly characterized by amyloid β (Aβ) plaques and neurofibrillary tangles. The disease involves widespread synaptic loss in the neocortex and the hippocampus. Rodent and clinical studies suggest that OSA impairs the structural integrity of several brain regions, including the medial temporal lobe. Indeed, hypoxia, hypertension, hypoperfusion, endothelial dysfunction, inflammation, and oxidative stress noted in OSA patients also occur in AD patients. This Review highlights pathological commonality, showing that OSA upregulates Aβ, tau hyperphosphorylation, and synaptic dysfunction. Indeed, OSA and hypertension trigger hypoperfusion and hypometabolism of brain regions, including cortex and hippocampus. Several studies show that hypertension-driven brain damage and pathogenic mechanisms lead to an Aβ increase. The pathophysiological mechanism by which OSA enhances hypertension may be linked to sympathoexcitation, oxidative stress, and endothelial dysfunction. Strong pathophysiological similarities that exist between OSA and AD are underscored here. For example, the hippocampus is negatively impacted in both OSA and AD. OSA promotes hippocampal atrophy, which is associated with memory impairment. Cognitive impairment, even in the absence of manifest dementia, is an important independent predictor of mortality. However, several pathophysiological mechanisms in OSA are reversible with appropriate therapy. OSA, therefore, is a modifiable risk factor of cognitive dysfunction, and treating OSA prior to mild cognitive impairment may be an effective prevention strategy to reduce risk for cognitive decline and AD in middle-aged persons and the elderly.

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A comparison between the AASM 2012 and 2007 definitions for detecting hypopnea

Abstract: A significant difference in detecting hypopnea events exists among the H 2012, H Rec and H Alt definitions. The 2007 AASM "Recommended" definition tended to result in lower AHI than the other two definitions.

Cited by 67 publications

References 19 publications

Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

Hypopnea: ‘rule of thumb’ or ruler and plumb?

Evidence of neurodegeneration in obstructive sleep apnea: Relationship between obstructive sleep apnea and cognitive dysfunction in the elderly

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