On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal

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On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal

Pevernagie, D. A. (author)

Gnidovec-Strazisar, B. (author)

Grote, Ludger, 1964 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine

Heinzer, R. (author)

McNicholas, W. T. (author)

Penzel, T. (author)

Randerath, W. (author)

Schiza, S. (author)

Verbraecken, J. (author)

Arnardottir, E. S. (author)

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(creator_code:org_t)

2020-05-14
2020
English.
In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 29:4

Related links:: https://onlinelibrar...; show more...; https://gup.ub.gu.se...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

The publication of "The Sleep Apnea Syndromes" by Guilleminault et al. in the 1970s hallmarked the discovery of a new disease entity involving serious health consequences. Obstructive sleep apnea was shown to be the most important disorder among the sleep apnea syndromes (SAS). In the course of time, it was found that the prevalence of obstructive sleep apnea reached the proportions of a global epidemic, with a major impact on public health, safety and the economy. Early on, a metric was introduced to gauge the seriousness of obstructive sleep apnea, based on the objective measurement of respiratory events during nocturnal sleep. The apnea index and later on the apnea-hypopnea index, being the total count of overnight respiratory events divided by the total sleep time in hours, were embraced as principle measures to establish the diagnosis of obstructive sleep apnea and to rate its severity. The current review summarises the historical evolution of the apnea-hypopnea index, which has been subject to many changes, and has been criticised for not capturing relevant clinical features of obstructive sleep apnea. In fact, the application of the apnea-hypopnea index as a continuous exposure variable is based on assumptions that it represents a disease state of obstructive sleep apnea and that evocative clinical manifestations are invariably caused by obstructive sleep apnea if the apnea-hypopnea index is above diagnostic threshold. A critical appraisal of the extensive literature shows that both assumptions are invalid. This conclusion prompts a reconsideration of the role of the apnea-hypopnea index as the prime diagnostic metric of clinically relevant obstructive sleep apnea.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)

Keyword

apnea-hypopnea index
bias
diagnosis
entanglement
severity rating
sleep apnea
obstructive sleep-apnea
positive airway pressure
respiratory events
cardiovascular outcomes
severity classification
daytime sleepiness
precision medicine
general-population
scoring criteria
definitions
Neurosciences & Neurology

Publication and Content Type

ref (subject category)
art (subject category)

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By the author/editor: Pevernagie, D. A ...; Gnidovec-Strazis ...; Grote, Ludger, 1 ...; Heinzer, R.; McNicholas, W. T ...; Penzel, T.; show more...; Randerath, W.; Schiza, S.; Verbraecken, J.; Arnardottir, E. ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...

Articles in the publication: Journal of Sleep ...

By the university: University of Gothenburg

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