CHEST Guidelines-POINT--Should-Hypopneas-Only-Be-Scored-When-Accomp

POINT--Should-Hypopneas-Only-Be-Scored-When-Accomp

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The document debates whether hypopneas should only be scored when accompanied by oxygen desaturation, with two expert perspectives presented. The apnea-hypopnea index (AHI) is a critical measure for diagnosing obstructive sleep apnea (OSA), and defining a hypopnea significantly impacts the reported prevalence of OSA.<br /><br />Aaron B. Holley, MD, and Barbara Phillips, MD, advocate for scoring hypopneas only when tied to oxygen desaturation, arguing it's clinically relevant and reproducible. They cite that including arousals in hypopnea definitions inflates OSA prevalence drastically, potentially misallocating healthcare resources. They argue that only desaturation correlates reliably with significant health outcomes and treatment response. Historical data suggests that desaturation-based scoring better identifies patients likely to benefit from interventions like positive airway pressure.<br /><br />In contrast, Nancy Collop, MD, and Richard Berry, MD, support the inclusion of arousal-based criteria, underscoring that arousals are linked to symptoms like sleepiness and fatigue. The American Academy of Sleep Medicine (AASM) supports this approach, suggesting it reflects a comprehensive view of potential sleep disruption impacts.<br /><br />Holley and Phillips caution against arousal-based scoring due to variability in scoring and emphasize the necessity of robust trials showing clinical benefit from treating OSA diagnosed by this method. For them, relying on desaturation alone is not a public health risk and would streamline healthcare focus and resource allocation.<br /><br />In conclusion, there's a debate between prioritizing oxygen desaturation for consistency and treatment correlation, versus a broader inclusion of sleep arousals which might identify more symptomatic patients but lacks substantial prospective data demonstrating treatment benefit. The outcome of this debate influences OSA diagnosis criteria and healthcare resources.

Keywords

hypopneas

oxygen desaturation

apnea-hypopnea index

obstructive sleep apnea

OSA prevalence

arousals

healthcare resources

positive airway pressure

American Academy of Sleep Medicine

sleep disruption