Reproducibility and predictors of the apnea hypopnea index across multiple nights

Alshaer, Hisham; Ryan, Clodagh; Bradley, Geoff R FernieT. Douglas

doi:10.5935/1984-0063.20180007

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…Notably, AHI already has a poor inter-night reproducibility due to various factors (sleep stage, position, diet, etc.) [36]. This was a retrospective analysis of data that had already been collected so it is prone to bias.…”

Section: Discussionmentioning

confidence: 99%

The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea—Regional Differences in Two Central–Eastern European Sleep Centers

Bikov

Frent²,

Pleavă³

et al. 2020

JCM

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Background: Obstructive sleep apnea (OSA) is usually associated with cardiovascular and cerebrovascular disease, metabolic syndrome and depression. Data on relevant OSA-associated comorbidities in Central–European populations are scarce. The aim of this study was to compare the prevalence of comorbidities in two OSA cohorts from Hungary and Romania. Methods: Data from 588 (282 from Hungary, 306 from Romania) untreated patients with OSA were retrospectively analyzed. The prevalence rates of hypertension, diabetes, dyslipidemia, allergic rhinitis, asthma, chronic obstructive pulmonary disease (COPD), osteoporosis, cerebrovascular and cardiovascular disease, arrhythmia and depression were compared between the two populations following adjustment for demographics, body mass index, smoking history, comorbidities and sleep parameters. Results: The prevalence rates of hypertension, arrhythmia, cerebrovascular and cardiovascular disease, diabetes and COPD in the whole study population were directly related to the severity of OSA. We found an inverse correlation between the prevalence of osteoporosis and OSA severity (all p < 0.05). Following adjustment, the prevalence of dyslipidemia was higher in the Hungarian cohort, whilst the prevalence of asthma, cardiovascular and cerebrovascular diseases was higher in the Romanian cohort (all p < 0.05). Conclusions: There was no difference in the prevalence rate of most comorbidities in patients with OSA from the two cohorts, except for dyslipidemia, asthma, cardiovascular and cerebrovascular disease.

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Section: Discussionmentioning

confidence: 99%

The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea—Regional Differences in Two Central–Eastern European Sleep Centers

Bikov

Frent²,

Pleavă³

et al. 2020

JCM

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“…Interscorer and intrascorer reliability is systematically assessed in each rater on a regular basis and has been deemed reliable. 12 Given previous reports of significant nightly fluctuation in sleep apnea severity, 8,9 SNAP Diagnostics encourages patients to wear the SNAP test for multiple nights to permit the assessment of possible sleep apnea across several occasions.…”

Section: Methodsmentioning

confidence: 99%

“…3 The use of HSAT may permit broader diagnostic reach; however, accurate diagnosis of OSA remains hampered by high levels of night-tonight fluctuations of OSA symptoms. 8,9 When using a standard diagnostic approach of a single night of testing, night-to-night fluctuations in test results could have profound implications for diagnostic validity and treatment utility.…”

Section: Introductionmentioning

confidence: 99%

Night-to-night fluctuations in sleep apnea severity: diagnostic and treatment implications

Dzierzewski

Dautovich

Rybarczyk

et al. 2020

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep apnea is a common disorder with serious consequences; however, effective treatments are available. Successful implementation of treatment strategies relies on accurate diagnosis, which may be hampered by the presence of substantial nightly fluctuation in sleep apnea severity. We examined the amount of nightly fluctuation in the severity of sleep apnea around commonly used diagnostic and treatment cut points in individuals who underwent two nights of home sleep apnea testing (HSAT). Methods: A nationwide retrospective cohort study of adults thought to have sleep apnea underwent two nights of HSAT between 2005 and 2017. Results: The study included 47,423 adults (mean age, 55.2 [14.6] years; 53.7% male). The average apnea-hypopnea index (AHI) for the sample was 26.9. The average amount of nightly fluctuation in AHI was 5.5. More than a third of the sample, 16,115 individuals, had fluctuations between diagnostic cut points across the two nights of HSAT. The negative predictive value of the HSAT in the first night was 47.42%, 73.57%, and 88.65% for detecting an AHI ≥ 5, AHI ≥ 15, and AHI ≥ 30, respectively. Conclusions: The addition of a second night of HSAT has the potential to reduce the likelihood of missed diagnoses that could result from nightly fluctuation in the severity of sleep apnea.

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“…Other issues to keep in mind in regard to the achievement of a universal prediction model for OA therapy, is that the outcome is based on the total AHI on a single night. We know AHI varies in polysomnography scoring, from night to night and depending on sleep stage and body position [59,60]. Additionally, its efficacy varies over time (e.g., with weight gain) [61,62].…”

Section: Factors Related To Oral Appliance Efficacy and Prediction Methodsmentioning

confidence: 99%

Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art

Sutherland

Cistulli

2019

JCM

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Obstructive sleep apnoea (OSA) represents a significant global health burden, with impact on cardiometabolic health, chronic disease, productivity loss and accident risk. Oral appliances (OA) are an effective therapy for OSA and work by enlarging and stabilising the pharyngeal airway to prevent breathing obstructions during sleep. Although recommended in clinical guidelines for OSA therapy, they are often considered only as second-line therapy following positive airway pressure (PAP) therapy failure. There has been a long-standing barrier to selecting OA over PAP therapy due to the inability to be certain about the level of efficacy in individual OSA patients. A range of methods to select OSA patients for OA therapy, based on the outcome of a single sleep study night, have been proposed, although none has been widely validated for clinical use. Emergent health outcome data suggest that equivalent apnoea–hypopnea index reduction may not be necessary to produce the same health benefits of PAP. This may be related to the more favourable adherence to OA therapy, which can now be objectively verified. Data on longer term health outcomes are needed, and there are additional opportunities for device improvement and combination therapy approaches. OAs have an important role in precision care of OSA as a chronic disorder through a multi-disciplinary care team. Future studies on real-world health outcomes following OA therapy are needed.

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Reproducibility and predictors of the apnea hypopnea index across multiple nights

Cited by 10 publications

References 24 publications

The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea—Regional Differences in Two Central–Eastern European Sleep Centers

The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea—Regional Differences in Two Central–Eastern European Sleep Centers

Night-to-night fluctuations in sleep apnea severity: diagnostic and treatment implications

Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art

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