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Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas.
Tuesday,2012-11-06 12:09 America/Los_Angeles — eenright
| Title | Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas. |
| Publication Type | Journal Article |
| Year of Publication | 2008 |
| Authors | Punjabi, NM, Newman, AB, Young, TB, Resnick, HE, Sanders, MH |
| Journal | Am J Respir Crit Care Med |
| Volume | 177 |
| Issue | 10 |
| Pagination | 1150-5 |
| Date Published | 2008 May 15 |
| ISSN | 1535-4970 |
| Keywords | Aged, Apnea, Cardiovascular Diseases, Cohort Studies, Female, Humans, Male, Middle Aged, Odds Ratio, Oxyhemoglobins, Polysomnography, Sleep Apnea Syndromes, Terminology as Topic |
| Abstract | <p><b>RATIONALE: </b>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.</p><p><b>OBJECTIVES: </b>The current investigation sought to assess the most appropriate definition for hypopneas that would be best correlated with cardiovascular disease.</p><p><b>METHODS: </b>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.</p><p><b>MEASUREMENTS AND MAIN RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p> |
| DOI | 10.1164/rccm.200712-1884OC |
| Alternate Journal | Am J Respir Crit Care Med |
| PubMed ID | 18276938 |
| PubMed Central ID | PMC2383996 |
| Grant List | U01-HL53937 / HL / NHLBI NIH HHS / United States U01-HL53940 / HL / NHLBI NIH HHS / United States U01-HL63463 / HL / NHLBI NIH HHS / United States U01-HL53934 / HL / NHLBI NIH HHS / United States U01-HL53931 / HL / NHLBI NIH HHS / United States U01-HL53938 / HL / NHLBI NIH HHS / United States U01-HL63429 / HL / NHLBI NIH HHS / United States U01-HL53916 / HL / NHLBI NIH HHS / United States U01-HL53941 / HL / NHLBI NIH HHS / United States |