Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment

• Published in: American journal of respiratory and critical care medicine Vol. 161; no. 2; pp. 369 - 374
• Main Authors: REDLINE, S, KAPUR, V. K, SANDERS, M. H, QUAN, S. F, GOTTLIEB, D. J, RAPOPORT, D. M, BONEKAT, W. H, SMITH, P. L, KILEY, J. P, IBER, C
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01.02.2000
• Subjects: Adult; Aged; Aged, 80 and over; Arousal - physiology; Biological and medical sciences; Diagnosis, Differential; Female; Humans; Lung Volume Measurements; Male; Medical sciences; Middle Aged; Observer Variation; Oxygen - blood; Oxyhemoglobins - metabolism; Pneumology; Polysomnography - methods; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - etiology; Sleep Apnea Syndromes - physiopathology; Human; Evaluation; Exploration; Sleep apnea syndrome; Respiratory disease; Classification
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.161.2.9904031

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.