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. 2013 Sep 1;36(9):1341-8.
doi: 10.5665/sleep.2960.

The effect of respiratory scoring on the diagnosis and classification of sleep disordered breathing in chronic heart failure

Neil R Ward  1 , Vitor Roldao, Martin R Cowie, Stuart D Rosen, Theresa A McDonagh, Anita K Simonds, Mary J Morrell
Affiliations

The effect of respiratory scoring on the diagnosis and classification of sleep disordered breathing in chronic heart failure

Neil R Ward et al. Sleep. .

Abstract

Study objectives: To evaluate the effect of respiratory scoring criteria on diagnosis and classification of sleep disordered breathing (SDB) in chronic heart failure (CHF).

Design: Cross-sectional observational study.

Setting: Heart failure and general cardiology clinics at two London hospitals.

Patients or participants: One hundred eighty stable patients with CHF and a median age of 69.6 y, 86% male.

Interventions: SDB was diagnosed by polysomnography. The apnea-hypopnea index (AHI) was initially scored using a conservative hypopnea definition of a ≥ 50% decrease in nasal airflow with a ≥ 4% oxygen desaturation. The AHI was rescored with hypopnea defined according to the American Academy of Sleep Medicine (AASM) alternative scoring rule, requiring an associated ≥ 3% oxygen desaturation or arousal. SDB was defined as AHI ≥ 15/h. Diagnosis and classification of SDB as obstructive sleep apnea (OSA) or central sleep apnea (CSA) with each rule were compared. The effect of mixed apneas on classification of SDB as CSA or OSA was also investigated.

Measurements and results: Median AHI increased from 9.3/h to 13.8/h (median difference 4.6/h) when the AASM alternative rule was used to score hypopneas. SDB prevalence increased from 29% to 46% with the alternative scoring rule (P < 0.001). Classification of SDB as OSA or CSA was not significantly altered by hypopnea scoring rules or the categorization of mixed apneas.

Conclusion: Hypopnea scoring rules can significantly influence the apnea-hypopnea index and diagnosis of sleep disordered breathing in chronic heart failure but do not alter the classification as obstructive sleep apnea or central sleep apnea. Standardization of hypopnea scoring rules is important to ensure consistency in diagnosis of sleep disordered breathing in chronic heart failure patients.

Keywords: Chronic heart failure; diagnosis; hypopnea; mixed apnea; scoring criteria; sleep disordered breathing.

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Figures

Figure 1
Figure 1
Difference versus average plot to show difference between apnea-hypopnea index (AHI) scored with the two hypopnea rules as a function of mean AHI. SD, standard deviation.
Figure 2
Figure 2
Number of patients with chronic heart failure in whom sleep disordered breathing was diagnosed using different hypopnea scoring criteria (n = 170). SDB, sleep disordered breathing
Figure 3
Figure 3
Classification of sleep disordered breathing in patients with chronic heart failure (n = 80). Data from each patient are displayed twice to show the percentage of central and obstructive sleep disordered breathing events. There was clear predominance of central or obstructive sleep disordered breathing events in most patients.
See this image and copyright information in PMC

Comment in

  • The map is not the territory.
    Leung RS. Leung RS. Sleep. 2013 Sep 1;36(9):1277-8. doi: 10.5665/sleep.2944. Sleep. 2013. PMID: 23997359 Free PMC article. No abstract available.

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