Implications of revised AASM rules on scoring apneic and hypopneic respiratory events in patients with heart failure with nocturnal Cheyne-Stokes respiration

• Published in: Sleep & breathing Vol. 19; no. 2; pp. 489 - 494
• Main Authors: Heinrich, Jessica, Spießhöfer, Jens, Bitter, Thomas, Horstkotte, Dieter, Oldenburg, Olaf
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2015; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Cheyne-Stokes Respiration - classification; Cheyne-Stokes Respiration - diagnosis; Cohort Studies; Dentistry; Female; Germany; Heart failure; Heart Failure - classification; Heart Failure - complications; Heart Failure - diagnosis; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Original Article; Otorhinolaryngology; Oxygen - blood; Pediatrics; Pneumology/Respiratory System; Polysomnography - classification; Polysomnography - methods; Prognosis; Respiration; Respiratory system; Sleep apnea; Sleep Apnea, Central - classification; Sleep Apnea, Central - diagnosis; Sleep Apnea, Obstructive - classification; Sleep Apnea, Obstructive - diagnosis; Germany; Cheyne-Stokes respiration; Heart failure; Apnea; AASM 2007 scoring rules; AASM 2012 scoring rules; Apnea-hypopnea index; Scoring; Hypopnea; Sleep-disordered breathing; Hypopnea index; Guidelines
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-014-1014-9

Study objectives This study investigated the implications of the revised scoring rules of the American Academy of Sleep Medicine (AASM) in patients with heart failure (HF) with Cheyne-Stokes respiration (CSR). Methods Ninety-one patients (NYHA ≥II, LVEF ≤45 %; age 73.6 ± 11.3 years old; 81 male subjects) with documented CSR underwent 8 h of cardiorespiratory polygraphy recordings. Those were analyzed by a single scorer strictly applying the 2007 recommended, 2007 alternative, and the 2012 scoring rules. Results Compared with the AASM 2007 recommended rules, apnea-hypopnea index (AHI) and hypopnea index (HI) increased significantly when the 2007 alternative and 2012 rules were applied (AHI 34.1 ± 13.5/h vs 37.6 ± 13.2/h vs 38.3 ± 13.2/h, respectively; HI 10.2 ± 9.4/h vs 13.7 ± 10.7/h vs 14.4 ± 11.0/h, respectively; all p  < 0.001). Duration of CSR increased significantly with the alternate versus recommended 2007 rules (182.2 ± 117.0 vs 170.1 ± 115.0 min; p  ≤ 0.001); there was a significant decrease in CSR duration for the 2012 versus 2007 alternative rules (182.2 ± 117.0 vs 166.7 ± 115.4 min; p  ≤ 0.001). Conclusion AHI was higher using the AASM 2012 scoring rules due to a less strict definition of hypopnea. Data on the prognostic effects of CSR in patients with HF and the benefits of treatment are mostly based on the AASM 2007 recommended rules, so differences between these and the newer version need to be taken into account.