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Published in: Sleep and Breathing 3/2022

26-09-2021 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

Sleepiness in obstructive sleep apnea using hypopneas defined by a 3% oxygen desaturation or arousal but not by 4% or greater oxygen desaturation

Authors: Rohit Budhiraja, Stuart F. Quan

Published in: Sleep and Breathing | Issue 3/2022

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Abstract

Study objectives

This analysis determined the association between obstructive sleep apnea (OSA) with hypopneas defined by a 3% O2 desaturation or arousal (3%A), but not by a hypopnea criterion of ≥ 4% (4%), and subjective sleepiness.

Methods

Data were analyzed from Sleep Heart Health Study participants who had polysomnography (N = 6307) regarding OSA and subjective sleepiness scores (Epworth Sleepiness Scale, ESS). The apnea hypopnea index (AHI) was classified based on 3% only, 3%A only, and 4% definitions of hypopneas.

Results

Of the 3326 participants without 4% OSA, 67.6% (n = 2247) had 3%A only OSA. The ESS score was higher in 3%A only OSA than in those without OSA (7.44 ± 4.2 vs 7.07 ± 4.3, P = 0.02). Of those without 4% OSA, 40.2% (n = 1336) had 3% only OSA. The ESS score was higher in those with 3% only OSA than those with no OSA (7.72 ± 4.3 vs 7.05 ± 4.2, P < 0.001). A linear regression model demonstrated a trend towards significance for the 3%A only AHI as an independent predictor of ESS when controlled for age, BMI, and sex (P = 0.051). The association of 3% only AHI with the ESS was stronger (P = 0.003). However, 23.3% of the participants with hypersomnia would not qualify as having OSA if arousals were excluded from the definition of OSA.

Conclusion

The current study found that the presence and severity of OSA is associated with higher ESS scores in persons with 3%A only OSA. Hence, the use of the 4% hypopnea definition will result in the failure to identify and treat a significant number of individuals with OSA who have subjective sleepiness.
Literature
5.
go back to reference Quan SF, Howard BV, Iber C et al (1997) The Sleep Heart Health Study: design, rationale, and methods. Sleep 20(12):1077–1085 PubMed Quan SF, Howard BV, Iber C et al (1997) The Sleep Heart Health Study: design, rationale, and methods. Sleep 20(12):1077–1085 PubMed
6.
go back to reference Redline S, Sanders MH, Lind BK et al (1998) Methods for obtaining and analyzing unattended polysomnography data for a multicenter study. Sleep Heart Health Research Group. Sleep 21(7):759–767 CrossRef Redline S, Sanders MH, Lind BK et al (1998) Methods for obtaining and analyzing unattended polysomnography data for a multicenter study. Sleep Heart Health Research Group. Sleep 21(7):759–767 CrossRef
7.
go back to reference Whitney CW, Gottlieb DJ, Redline S et al (1998) Reliability of scoring respiratory disturbance indices and sleep staging. Sleep 21(7):749–757 CrossRef Whitney CW, Gottlieb DJ, Redline S et al (1998) Reliability of scoring respiratory disturbance indices and sleep staging. Sleep 21(7):749–757 CrossRef
8.
go back to reference Rechtschaffen A, Kales A (1968) A manual of standardized terminology, technique and scoring system for sleep stages of human sleep. Brain Information Service, Los Angeles Rechtschaffen A, Kales A (1968) A manual of standardized terminology, technique and scoring system for sleep stages of human sleep. Brain Information Service, Los Angeles
10.
go back to reference Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545 CrossRef Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545 CrossRef
13.
go back to reference Bonnet MH, Doghramji K, Roehrs T et al (2007) The scoring of arousal in sleep: reliability, validity, and alternatives. J Clin Sleep Med 3(2):133–145 CrossRef Bonnet MH, Doghramji K, Roehrs T et al (2007) The scoring of arousal in sleep: reliability, validity, and alternatives. J Clin Sleep Med 3(2):133–145 CrossRef
Metadata
Title
Sleepiness in obstructive sleep apnea using hypopneas defined by a 3% oxygen desaturation or arousal but not by 4% or greater oxygen desaturation
Authors
Rohit Budhiraja
Stuart F. Quan
Publication date
26-09-2021
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 3/2022
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-021-02494-x

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