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Correspondence |

Hypopnea Scoring in the Sleep Heart Health StudyResponse FREE TO VIEW

Stuart F. Quan, MD, FCCP; Susan Redline, MD, MPH
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Affiliations: Harvard Medical School, Boston, MA,  Case Western Reserve University, Cleveland, OH,  Chair and Editor-in-Chief, SLEEP 2 (Study Lessons in Education and Evaluation of Polysomnography), Baltimore, MD

Correspondence to: Stuart F. Quan, MD, FCCP, Harvard Medical School, Division of Sleep Medicine, 401 Park Dr, 2nd Floor, Boston, MA 02215; e-mail: squan@resp-sci.arizona.edu



Chest. 2008;133(4):1054-1055. doi:10.1378/chest.07-2877
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It has come to our attention that the American College of Chest Physicians CD, “Sleep: Study Lessons in Education; product code 6633” has misinterpreted some of the findings from the Sleep Heart Health Study (SHHS). In the section, “Sleep-Disordered Breathing Events: Question 5, A. Hypopnea,” it is stated that “In fact, the scorers of the polysomnographies in the SHHS required a 4% oxyhemoglobin desaturation in order to score either apneas or hypopneas, because they could not achieve inter-rater reliability of apneas and hypopneas otherwise. Thus, the SHHS outcome data are essentially based on oximetry.” These two sentences are incorrect. Although it is true that the SHHS requires a 4% oxygen desaturation as one of its criteria to identify a hypopnea in most of its publications, this desaturation criterion was not chosen because we were unable to otherwise obtain interrater reliability using other criteria. Rather, a 4% oxygen desaturation was chosen because we wished to be consistent with the scoring criteria used by the Wisconsin Sleep Cohort so that comparisons could be made between the studies. Moreover, in the article by Whitney et al,1 we demonstrated that the intraclass correlation coefficients using various oxygen desaturation criteria were all > 0.90.

We hope that this error will not be perpetuated in future editions of the education CDs on polysomnography, and that readers of CHEST who also use the Sleep Study Lessons CD will realize that this statement is not correct.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Whitney, CW, Gottlieb, DJ, Redline, S, et al (1998) Reliability of scoring respiratory disturbance indices and sleep staging.Sleep21,749-757. [PubMed]
 
To the Editor:

In response to the letter of Drs. Quan and Redline regarding the American College of Chest Physicians (ACCP) product No. 6633, “SLEEP 2-Study Lessons in the Education and Evaluation of Polysomnography,” it is noted that question 5 in the “Sleep-Disordered Breathing Events” section contains a statement pertaining to oxygen desaturation as it was used to identify hypopneas by a study cited as a reference in the product.

The ACCP acknowledges the inaccuracy, and that the criterion in question was included as a means to make comparisons with the data of other studies.


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References

Whitney, CW, Gottlieb, DJ, Redline, S, et al (1998) Reliability of scoring respiratory disturbance indices and sleep staging.Sleep21,749-757. [PubMed]
 
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