03134nas a2200349 4500008004100000022001400041245010100055210006900156260001600225300001100241490000800252520216200260653000902422653001002431653002802441653001902469653001102488653001102499653000902510653001602519653001502535653001902550653002002569653002602589653002502615100002302640700002002663700002002683700002402703700002102727856003602748 2008 eng d a1535-497000aSleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas.0 aSleepdisordered breathing and cardiovascular disease an outcomeb c2008 May 15 a1150-50 v1773 a

RATIONALE: Epidemiologic studies on the consequences of sleep-disordered breathing invariably use the apnea-hypopnea index as the primary measure of disease severity. Although hypopneas constitute a majority of disordered breathing events, significant controversy remains about the best criteria used to define these events.

OBJECTIVES: The current investigation sought to assess the most appropriate definition for hypopneas that would be best correlated with cardiovascular disease.

METHODS: A community sample of middle-aged and older adults was recruited as part of the Sleep Heart Health Study. Full-montage polysomnography was conducted and hypopneas were defined using different thresholds of oxyhemoglobin desaturation with and without arousals. Prevalent cardiovascular disease was assessed based on self-report. Logistic regression analysis was used to characterize the independent association between the hypopnea index and prevalent cardiovascular disease.

MEASUREMENTS AND MAIN RESULTS: Using a sample of 6,106 adults with complete data on cardiovascular disease status and polysomnography, the current study found that hypopneas associated with an oxyhemoglobin desaturation of 4% or more were associated with prevalent cardiovascular disease independent of confounding covariates. The adjusted prevalent odds ratios for quartiles of the hypopnea index using a 4% desaturation criterion were as follows: 1.00 (<1.10 events/h), 1.10 (1.01-3.20 events/h), 1.33 (3.21-7.69 events/h), and 1.41 (>7.69 events/h). Hypopnea measures based on less than 4% oxyhemoglobin desaturation or presence of arousals showed no association with cardiovascular disease.

CONCLUSIONS: Hypopneas comprise a significant component of sleep-disordered breathing in the general community. By varying the criteria for defining hypopneas, this study demonstrates that hypopneas with a desaturation of at least 4% are independently associated with cardiovascular disease. In contrast, no association was observed between cardiovascular disease and hypopneas associated with milder desaturations or arousals.

10aAged10aApnea10aCardiovascular Diseases10aCohort Studies10aFemale10aHumans10aMale10aMiddle Aged10aOdds Ratio10aOxyhemoglobins10aPolysomnography10aSleep Apnea Syndromes10aTerminology as Topic1 aPunjabi, Naresh, M1 aNewman, Anne, B1 aYoung, Terry, B1 aResnick, Helaine, E1 aSanders, Mark, H uhttps://chs-nhlbi.org/node/1018