Am. J. Respir. Crit. Care Med., Volume 161, Number 2, February 2000, 369-374

Effects of Varying Approaches for Identifying Respiratory Disturbances on Sleep Apnea Assessment

SUSAN REDLINE, VISHESH K. KAPUR, MARK H. SANDERS, STUART F. QUAN, DANIEL J. GOTTLIEB, DAVID M. RAPOPORT, WILLIAM H. BONEKAT, PHILIP L. SMITH, JAMES P. KILEY, and CONRAD IBER, for the Sleep Heart Health Research Group

Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; Department of Medicine, University of Washington, Seattle, Washington; Departments of Medicine and Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Medicine and Respiratory Sciences Center, University of Arizona, Tucson, Arizona; Department of Medicine, Boston University, Boston, Massachusetts; Department of Medicine, New York University, New York, New York; Department of Medicine, University of California, Davis, California; Department of Medicine, Johns Hopkins University, Baltimore, Maryland; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; and Department of Medicine, University of Minnesota, Minneapolis, Minnesota

Varying approaches to measuring the respiratory disturbance index (RDI) may lead to discrepant estimates of the severity of sleep-disordered breathing (SDB). In this study, we assessed the impact of varying the use of corroborative data (presence and degree of desaturation and/or arousal) to identify hypopneas and apneas. The relationships among 10 RDIs defined by various definitions of apneas and hypopneas were assessed in 5,046 participants in the Sleep Heart Health Study (SHHS) who underwent overnight unattended 12-channel polysomnography (PSG). The magnitude of the median RDI varied 10-fold (i.e., 29.3 when the RDI was based on events identified on the basis of flow or volume amplitude criteria alone to 2.0 for an RDI that required an associated 5% desaturation with events). The correlation between RDIs based on different definitions ranged from 0.99 to 0.68. The highest correlations were among RDIs that required apneas and hypopneas to be associated with some level of desaturation. Lower correlations were observed between RDIs that required desaturation as compared with RDIs defined on the basis of amplitude criteria alone or associated arousal. These data suggest that different approaches for measuring the RDI may contribute to substantial variability in identification and classification of the disorder. Redline S, Kapur VK, Sanders MH, Quan SF, Gottlieb DJ, Rapoport DM, Bonekat WH, Smith PL, Kiley JP, Iber C. Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment.

This article has been cited by other articles:

				J. F. Masa, J. Corral, J. Teran, M. J. Martin, C. Disdier, M. Rubio, M. Mota, J. Zamorano, and J. M. Montserrat Apnoeic and obstructive nonapnoeic sleep respiratory events Eur. Respir. J., July 1, 2009; 34(1): 156 - 161. [Abstract] [Full Text] [PDF]

				K. Champagne, K. Schwartzman, L. Opatrny, P. Barriga, L. Morin, A. Mallozzi, A. Benjamin, and R. J. Kimoff Obstructive sleep apnoea and its association with gestational hypertension Eur. Respir. J., March 1, 2009; 33(3): 559 - 565. [Abstract] [Full Text] [PDF]

				H. K. Yaggi Obstructive Sleep Apnea-Hypopnea Syndrome: Definitions, Epidemiology, and Pathogenesis ACCP Sleep Med Brd Rev, January 1, 2009; 4(0): 185 - 192. [Full Text] [PDF]

				W. T. McNicholas Diagnosis of Obstructive Sleep Apnea in Adults Proceedings of the ATS, February 15, 2008; 5(2): 154 - 160. [Abstract] [Full Text] [PDF]

				V Jobin, P Mayer, and F Bellemare Predictive value of automated oxygen saturation analysis for the diagnosis and treatment of obstructive sleep apnoea in a home-based setting Thorax, May 1, 2007; 62(5): 422 - 427. [Abstract] [Full Text] [PDF]

				S. M. Caples, A. S. Gami, and V. K. Somers Obstructive Sleep Apnea Focus, October 1, 2005; 3(4): 557 - 567. [Full Text] [PDF]

				M. J. Mador, T. J. Kufel, U. J. Magalang, S. K. Rajesh, V. Watwe, and B. J. B. Grant Prevalence of Positional Sleep Apnea in Patients Undergoing Polysomnography Chest, October 1, 2005; 128(4): 2130 - 2137. [Abstract] [Full Text] [PDF]

				P. R. Westbrook, D. J. Levendowski, M. Cvetinovic, T. Zavora, V. Velimirovic, D. Henninger, and D. Nicholson Description and Validation of the Apnea Risk Evaluation System: A Novel Method To Diagnose Sleep Apnea-Hypopnea in the Home Chest, October 1, 2005; 128(4): 2166 - 2175. [Abstract] [Full Text] [PDF]

				S. M. Caples, A. S. Gami, and V. K. Somers Obstructive Sleep Apnea Ann Intern Med, February 1, 2005; 142(3): 187 - 197. [Full Text] [PDF]

				I. Fietze, K. Dingli, K. Diefenbach, N.J. Douglas, M. Glos, M. Tallafuss, W. Terhalle, and C. Witt Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome Eur. Respir. J., December 1, 2004; 24(6): 987 - 993. [Abstract] [Full Text] [PDF]

				W. H. Tsai, J.-C. Vazquez, T. Oshima, L. Dort, B. Roycroft, A. A. Lowe, E. Hajduk, and J. E. Remmers Remotely Controlled Mandibular Positioner Predicts Efficacy of Oral Appliances in Sleep Apnea Am. J. Respir. Crit. Care Med., August 15, 2004; 170(4): 366 - 370. [Abstract] [Full Text] [PDF]

				D Schlosshan and M W Elliott Sleep * 3: Clinical presentation and diagnosis of the obstructive sleep apnoea hypopnoea syndrome Thorax, April 1, 2004; 59(4): 347 - 352. [Abstract] [Full Text] [PDF]

				F. J. Nieto, D. M. Herrington, S. Redline, E. J. Benjamin, and J. A. Robbins Sleep Apnea and Markers of Vascular Endothelial Function in a Large Community Sample of Older Adults Am. J. Respir. Crit. Care Med., February 1, 2004; 169(3): 354 - 360. [Abstract] [Full Text] [PDF]

				J R Stradling and R J O Davies Sleep {middle dot} 1: Obstructive sleep apnoea/hypopnoea syndrome: definitions, epidemiology, and natural history Thorax, January 1, 2004; 59(1): 73 - 78. [Abstract] [Full Text] [PDF]

				U. J. Magalang, J. Dmochowski, S. Veeramachaneni, A. Draw, M. J. Mador, A. El-Solh, and B. J. B. Grant Prediction of the Apnea-Hypopnea Index From Overnight Pulse Oximetry Chest, November 1, 2003; 124(5): 1694 - 1701. [Abstract] [Full Text] [PDF]

				M. T. Naughton Cycling Sleep Apnea: The Balance of Compensated and Decompensated Breathing Am. J. Respir. Crit. Care Med., September 15, 2003; 168(6): 624 - 625. [Full Text] [PDF]

				F.J. O'Donoghue, P.G. Catcheside, E.E. Ellis, R.R. Grunstein, R.J. Pierce, L.S. Rowland, E.R. Collins, S.E. Rochford, and R.D. McEvoy Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors Eur. Respir. J., June 1, 2003; 21(6): 977 - 984. [Abstract] [Full Text] [PDF]

				W. H. Tsai, J. E. Remmers, R. Brant, W. W. Flemons, J. Davies, and C. Macarthur A Decision Rule for Diagnostic Testing in Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., May 15, 2003; 167(10): 1427 - 1432. [Abstract] [Full Text] [PDF]

				H. E. Resnick, S. Redline, E. Shahar, A. Gilpin, A. Newman, R. Walter, G. A. Ewy, B. V. Howard, and N. M. Punjabi Diabetes and Sleep Disturbances: Findings from the Sleep Heart Health Study Diabetes Care, March 1, 2003; 26(3): 702 - 709. [Abstract] [Full Text] [PDF]

				S. T. Kuna A 54-Year-Old Man With Obstructive Sleep Apnea JAMA, October 23, 2002; 288(16): 2032 - 2039. [Full Text] [PDF]

				J. M. Montserrat and R. Farre Breathing Flow Disturbances during Sleep: Can They Be Accurately Assessed by Nasal Prongs? Am. J. Respir. Crit. Care Med., August 1, 2002; 166(3): 259 - 260. [Full Text] [PDF]

				S. Boyer and V. Kapur Obstructive Sleep Apnea: Its Relevance in the Care of Diabetic Patients Clin. Diabetes, July 1, 2002; 20(3): 126 - 132. [Abstract] [Full Text] [PDF]

				T. Young, P. E. Peppard, and D. J. Gottlieb Epidemiology of Obstructive Sleep Apnea: A Population Health Perspective Am. J. Respir. Crit. Care Med., May 1, 2002; 165(9): 1217 - 1239. [Abstract] [Full Text] [PDF]

				C. F. P. George, L. J. Findley, M. A. Hack, and R. D. McEvoy Across-Country Viewpoints on Sleepiness during Driving Am. J. Respir. Crit. Care Med., March 15, 2002; 165(6): 746 - 749. [Full Text] [PDF]

				R. THURNHEER, X. XIE, and K. E. BLOCH Accuracy of Nasal Cannula Pressure Recordings for Assessment of Ventilation during Sleep Am. J. Respir. Crit. Care Med., November 15, 2001; 164(10): 1914 - 1919. [Abstract] [Full Text] [PDF]

				J. F. Piccirillo More Information Needed About the Long-term Health Consequences of Mild to Moderate Obstructive Sleep Apnea Arch Otolaryngol Head Neck Surg, November 1, 2001; 127(11): 1400 - 1401. [Full Text] [PDF]

				M. J. TOBIN Sleep-disordered Breathing, Control of Breathing, Respiratory Muscles, Pulmonary Function Testing, Nitric Oxide, and Bronchoscopy in AJRCCM 2000 Am. J. Respir. Crit. Care Med., October 15, 2001; 164(8): 1362 - 1375. [Full Text] [PDF]

				U. C. GUIDRY, L. A. MENDES, J. C. EVANS, D. LEVY, G. T. O'CONNOR, M. G. LARSON, D. J. GOTTLIEB, and E. J. BENJAMIN Echocardiographic Features of the Right Heart in Sleep-Disordered Breathing . The Framingham Heart Study Am. J. Respir. Crit. Care Med., September 15, 2001; 164(6): 933 - 938. [Abstract] [Full Text] [PDF]

				R. L. Manser, P. Rochford, R. J. Pierce, G. B. Byrnes, and D. A. Campbell Impact of Different Criteria for Defining Hypopneas in the Apnea-Hypopnea Index Chest, September 1, 2001; 120(3): 909 - 914. [Abstract] [Full Text] [PDF]

				J.-J. HOSSELET, I. AYAPPA, R. G. NORMAN, A. C. KRIEGER, and D. M. RAPOPORT Classification of Sleep-disordered Breathing Am. J. Respir. Crit. Care Med., February 1, 2001; 163(2): 398 - 405. [Abstract] [Full Text]

				R. FARRÉ, J. RIGAU, J. M. MONTSERRAT, E. BALLESTER, and D. NAVAJAS Relevance of Linearizing Nasal Prongs for Assessing Hypopneas and Flow Limitation During Sleep Am. J. Respir. Crit. Care Med., February 1, 2001; 163(2): 494 - 497. [Abstract] [Full Text]

				E. SHAHAR, C. W. WHITNEY, S. REDLINE, E. T. LEE, A. B. NEWMAN, F. JAVIER NIETO, G. T. O'CONNOR, L. L. BOLAND, J. E. SCHWARTZ, and J. M. SAMET Sleep-disordered Breathing and Cardiovascular Disease . Cross-sectional Results of the Sleep Heart Health Study Am. J. Respir. Crit. Care Med., January 1, 2001; 163(1): 19 - 25. [Abstract] [Full Text]