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Correspondence |

Going Beyond the Apnea-Hypopnea Index FREE TO VIEW

Tetyana Kendzerska, MD, PhD; Richard S. Leung, MD, PhD
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FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Tetyana Kendzerska, MD, PhD, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre/Sunnybrook Research Institute, G1 06, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(5):1349-1350. doi:10.1016/j.chest.2016.02.671
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We read with interest the recent Point and Counterpoint between Rapoport and Punjabi published in CHEST (January 2016), on the clinical significance of apnea-hypopnea index (AHI) as the measure of the severity of sleep-disordered breathing. In particular, we share Punjabi’s viewpoint that the AHI is a crude and imprecise metric and that any measure of OSA severity should capture the pathophysiologic diversity of the disease process.

Although we agree completely with Punjabi that several different parameters are needed to reflect disease complexity, we do not completely agree with the statement that “In most, if not all, available studies on the health significance of OSA to date, the AHI has been used as the primary exposure or independent variable and has been correlated with specific outcomes of interest.”(p17) In fact, we conducted and published a historical cohort study of more than 10,000 patients that evaluated the relationship between a comprehensive set of OSA-related variables and the development of cardiovascular outcomes and all-cause mortality after controlling for traditional risk factors. We hypothesized that the AHI is not by itself sufficient to accurately predict these adverse outcomes, and expanded the set of predictive factors to include patient demographic and clinical characteristics and numerous other physiologic measurements collected during polysomnography. We found that AHI was markedly inferior to other predictors, such as sleep time spent with oxygen desaturation less than 90%. As such, we are not satisfied with an AHI as an isolated measure, and agree that by focusing exclusively on AHI, clinicians and researchers may have missed opportunities to better risk-stratify patients.

References

Rapoport D. . Point: Is the apnea-hypopnea index the best way to quantify the severity of sleep-disordered breathing? Yes. Chest. 2016;149:14-16 [PubMed]journal. [CrossRef] [PubMed]
 
Punjabi N. . Counterpoint: Is the apnea-hypopnea index the best way to quantify the severity of sleep-disordered breathing? No. Chest. 2016;149:16-19 [PubMed]journal. [CrossRef] [PubMed]
 
Kendzerska T. .Gershon A.S. .Hawker G. .Leung R.S. .Tomlinson G. . Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2014;11:e1001599- [PubMed]journal. [CrossRef] [PubMed]
 
Edwards B.A. .Wellman A. .Owens R.L. . PSGs: more than just the AHI. J Clin Sleep Med. 2013;9:527-528 [PubMed]journal. [PubMed]
 

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References

Rapoport D. . Point: Is the apnea-hypopnea index the best way to quantify the severity of sleep-disordered breathing? Yes. Chest. 2016;149:14-16 [PubMed]journal. [CrossRef] [PubMed]
 
Punjabi N. . Counterpoint: Is the apnea-hypopnea index the best way to quantify the severity of sleep-disordered breathing? No. Chest. 2016;149:16-19 [PubMed]journal. [CrossRef] [PubMed]
 
Kendzerska T. .Gershon A.S. .Hawker G. .Leung R.S. .Tomlinson G. . Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2014;11:e1001599- [PubMed]journal. [CrossRef] [PubMed]
 
Edwards B.A. .Wellman A. .Owens R.L. . PSGs: more than just the AHI. J Clin Sleep Med. 2013;9:527-528 [PubMed]journal. [PubMed]
 
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