On the rise and fall of the apnea−hypopnea index: A historical review and critical appraisal

Journal of Sleep Research, Journal Year: 2020, Volume and Issue: 29(4)

Published: May 14, 2020

Summary The publication of “The Sleep Apnea Syndromes” by Guilleminault et al. in the 1970s hallmarked discovery a new disease entity involving serious health consequences. Obstructive sleep apnea was shown to be most important disorder among syndromes (SAS). In course time, it found that prevalence obstructive reached proportions global epidemic, with major impact on public health, safety and economy. Early on, metric introduced gauge seriousness apnea, based objective measurement respiratory events during nocturnal sleep. index later apnea−hypopnea index, being total count overnight divided time hours, were embraced as principle measures establish diagnosis rate its severity. current review summarises historical evolution which has been subject many changes, criticised for not capturing relevant clinical features apnea. fact, application continuous exposure variable is assumptions represents state evocative manifestations are invariably caused if above diagnostic threshold. A critical appraisal extensive literature shows both invalid. This conclusion prompts reconsideration role prime clinically

Language: Английский

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Normal polysomnography parameters in healthy adults: a systematic review and meta-analysis

The Lancet Respiratory Medicine, Journal Year: 2019, Volume and Issue: 7(6), P. 533 - 543

Published: April 18, 2019

Language: Английский

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Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea

Journal of Dental Research, Journal Year: 2019, Volume and Issue: 99(1), P. 26 - 35

Published: Nov. 8, 2019

This critical review focuses on obstructive sleep apnea (OSA) and its management from a dental medicine perspective. OSA is characterized by ≥10-s cessation of breathing (apnea) or reduction in airflow (hypopnea) ≥5 times per hour with drop oxygen and/or rise carbon dioxide. It can be associated sleepiness fatigue, impaired mood cognition, cardiometabolic complications, risk for transportation work accidents. Although diagnosed physician, interdisciplinary. The dentist’s role includes 1) screening patients factors (e.g., retrognathia, high arched palate, enlarged tonsils tongue, tori, Mallampati score, poor sleep, supine position, obesity, hypertension, morning headache orofacial pain, bruxism); 2) referring to an appropriate health professional as indicated; 3) providing oral appliance therapy followed regular medical follow-up. In addition the device features provider expertise, anatomic, behavioral, demographic, neurophysiologic characteristics influence effectiveness managing OSA. Therefore, treatment should tailored each patient individually. highlights some putative action mechanisms related proposes future research directions.

Language: Английский

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A transition to the American Academy of Sleep Medicine–recommended hypopnea definition in adults: initiatives of the Hypopnea Scoring Rule Task Force

Journal of Clinical Sleep Medicine, Journal Year: 2022, Volume and Issue: 18(5), P. 1419 - 1425

Published: Feb. 24, 2022

The American Academy of Sleep Medicine (AASM) recommends that hypopneas be identified using a definition is based on ≥ 30% decrease in airflow associated with 3% reduction the oxygen saturation or an arousal (H3A) for diagnosis obstructive sleep apnea (OSA) adults. This conflicts Centers Medicare & Medicaid Services definition, which requires 4% to identify hypopnea (H4) and does not acknowledge arousals. In 2018, AASM Board Directors constituted Hypopnea Scoring Rule Task Force mandate "create strategy adoption implementation recommended adult scoring criteria among members, payers device manufacturers." task force initiated several activities including survey AASM-accredited facilities discussions polysomnography software vendors. Survey results indicated most scored polysomnograms only definition. Vendors they could easily support dual scoring. Informal testing members' confirmed there would little additional work if was performed. convened meetings working group OSA content experts interested parties, purpose creating research recommendations study impact relevant clinical outcomes different definitions hypopnea. Several possible prospective retrospective approaches were discussed emphasis patients diagnosed apnea-hypopnea index H3A but H4. Based deliberations group, submitted Foundation concerning project strategies potential grant funding. Further within focused developing advocacy initiatives patient stakeholder groups change payer policy.Berry RB, Abreu AR, Krishnan V, Quan SF, Strollo PJ Jr, Malhotra RK. A transition Medicine-recommended adults: Force. J Clin Med. 2022;18(5):1419-1425.

Language: Английский

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Association of obstructive sleep apnea with cardiometabolic diseases and cardiovascular mortality

The Clinical Respiratory Journal, Journal Year: 2023, Volume and Issue: 17(8), P. 764 - 770

Published: July 21, 2023

Obstructive sleep apnea (OSA) is one of the leading respiratory disorders, increasing risk cardiometabolic diseases. In study, we investigated association between OSA and diseases all-cause cardiovascular mortality in adults.Participants were enrolled National Health Nutrition Examination Survey. The baseline covariates compared participants with without status. Multivariable logistic regression was performed to explore diseases, while Cox proportional for mortality.OSA status positively associated higher risks including hypertension (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.14-1.45; p < 0.001), diabetes (OR 1.46, CI 1.22-1.76; 1.29, 1.08-1.54; = 0.006) after adjusting numerous covariates. However, no associations or observed.OSA a hypertension, diabetes, but had significant adults.

Language: Английский

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Achieving Better Understanding of Obstructive Sleep Apnea Treatment Effects on Cardiovascular Disease Outcomes through Machine Learning Approaches: A Narrative Review

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(5), P. 1415 - 1415

Published: Feb. 29, 2024

Obstructive sleep apnea (OSA) affects almost a billion people worldwide and is associated with myriad of adverse health outcomes. Among the most prevalent morbid are cardiovascular diseases (CVDs). Nonetheless, randomized controlled trials (RCTs) OSA treatment have failed to show improvements in CVD A major limitation our field lack precision defining specifically subgroups potential benefit from therapy. Further, this has called into question validity using time-honored apnea-hypopnea index as ultimate criteria for OSA. Recent applications advanced statistical methods machine learning brought light variety endotypes phenotypes. These also provide an opportunity understand interaction between comorbid better risk stratification. Lastly, heterogeneous effects modeling can help uncover differential outcomes after initiation. In era data sharing big data, these techniques will be at forefront research. Advanced science methods, such machine-learning analyses artificial intelligence, improve ability determine unique influence on ultimately allow us medicine approaches patients reduction. narrative review, we highlight how team via intelligence applied existing clinical polysomnography, proteomics, imaging do just that.

Language: Английский

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A Randomized, Controlled, Pilot Study of CPAP for Patients with Chronic Cough and Obstructive Sleep Apnea

Lung, Journal Year: 2020, Volume and Issue: 198(3), P. 449 - 457

Published: April 30, 2020

Language: Английский

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Obstructive Sleep Apnea Patients With Atrial Arrhythmias Suffer From Prolonged Recovery From Desaturations

IEEE Transactions on Biomedical Engineering, Journal Year: 2023, Volume and Issue: 70(7), P. 2122 - 2130

Published: Jan. 12, 2023

Objective: We aimed to investigate how acute and long-term effects of atrial arrhythmias affect the desaturation severity characteristics determined from oxygen saturation signal in OSA patients. xmlns:xlink="http://www.w3.org/1999/xlink">Methods: 520 suspected patients were included retrospective analyses. Eight area slope parameters calculated blood signals recorded during polysomnographic recordings. Patients grouped based on whether they had previously diagnosed arrhythmia (i.e., fibrillation (AFib) or flutter) not. Furthermore, with a previous diagnosis sub-grouped continuous AFib sinus rhythm Empirical cumulative distribution functions linear mixed models utilized connection between characteristics. xmlns:xlink="http://www.w3.org/1999/xlink">Results: greater recovery when 100% baseline reference was considered (β=0.150-0.127, xmlns:xlink="http://www.w3.org/1999/xlink">p ≤0.039) more gradual slopes (β=-0.181- -0.199, <0.004) than without diagnosis. fall rhythm. xmlns:xlink="http://www.w3.org/1999/xlink">Conclusion: Desaturation contains essential information about cardiovascular response hypoxemic periods. xmlns:xlink="http://www.w3.org/1999/xlink">Significance: More comprehensive consideration section could provide detailed severity, for example developing new diagnostic parameters.

Language: Английский

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Frequency of flow limitation using airflow shape

SLEEP, Journal Year: 2021, Volume and Issue: 44(12)

Published: July 8, 2021

The presence of flow limitation during sleep is associated with adverse health consequences independent obstructive apnea (OSA) severity (apnea-hypopnea index, AHI), but remains extremely challenging to quantify. Here we present a unique library and an accompanying automated method that apply investigate sleep.A 117,871 breaths (N = 40 participants) were visually classified (certain limitation, possible normal) using airflow shape physiological signals (ventilatory drive per intra-esophageal diaphragm EMG). An ordinal regression model was developed quantify certainty flow-shape features (e.g. flattening, scooping); breath-by-breath agreement (Cohen's ƙ); overnight frequency (R2, %breaths in certain or categories sleep) compared against visual scoring. Subsequent application examined arousals stable breathing, associations ventilatory drive.The (23 features) assessed good (breath-by-breath ƙ 0.572, p < 0.001) minimal error (overnight R2 0.86, 7.2%). Flow largely AHI (R2 0.16) varied widely within individuals OSA (74[32-95]%breaths, mean[range], > 15/h, N 22). unexpectedly frequent variable (40[5-85]%breaths) breathing (58[12-91]%breaths), elevated 0.26-0.29; 0.01 v. drive).Our enables quantification frequency, key aspect sleep-disordered the often unavailable. varies between individuals, prevalent reveals drive. Clinical trial registration: current observational physiology study does not qualify as clinical trial.

Language: Английский

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Coupling analysis of heart rate variability and cortical arousal using a deep learning algorithm

PLoS ONE, Journal Year: 2023, Volume and Issue: 18(4), P. e0284167 - e0284167

Published: April 6, 2023

Frequent cortical arousal is associated with cardiovascular dysfunction among people sleep-disordered breathing. Changes in heart rate variability (HRV) can represent pathological conditions autonomic nervous system dysfunction. Previous studies showed changes cardiac activity due to arousals. However, few have examined the instantaneous association between and HRV an ethnically diverse population. In this study, we included 1,069 subjects’ full night ECG signals from unattended polysomnography Multi-Ethnic Study of Atherosclerosis dataset. An automated deep learning tool was employed annotate events signals. The etiology (e.g., respiratory, or spontaneous) each event classified through a temporal analysis. Time domain HRVs mean were calculated on pre-, intra-, post-arousal segments 25-s period for event. We observed that increased during onsets intra-arousal segments, regardless etiology. Furthermore, response occurrence differed according gender sleep stages which occurred. more intense variation females contribute potentially stronger burden long-term mortality. excessive abrupt sympathetic tone elevation REM caused by may provide insights sudden death.

Language: Английский

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