%0 Journal Article %J Am J Respir Crit Care Med %D 2008 %T Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas. %A Punjabi, Naresh M %A Newman, Anne B %A Young, Terry B %A Resnick, Helaine E %A Sanders, Mark H %K Aged %K Apnea %K Cardiovascular Diseases %K Cohort Studies %K Female %K Humans %K Male %K Middle Aged %K Odds Ratio %K Oxyhemoglobins %K Polysomnography %K Sleep Apnea Syndromes %K Terminology as Topic %X

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.

%B Am J Respir Crit Care Med %V 177 %P 1150-5 %8 2008 May 15 %G eng %N 10 %1 https://www.ncbi.nlm.nih.gov/pubmed/18276938?dopt=Abstract %R 10.1164/rccm.200712-1884OC