Does AHI Value Enough for Evaluating the Obstructive Sleep Apnea Severity?
Yusuf Dundar • Guleser Saylam • Emel C¸ adallı Tatar • Ali Ozdek • Hakan Korkmaz • Hikmet Fırat • Sadık Ardıc
Received: 5 March 2014 / Accepted: 5 April 2014 / Published online: 19 April 2014 Association of Otolaryngologists of India 2014
Abstract:
Obstructive sleep apnea/hypopnea syndrome (OSAHS) is an important and more common public health problem with increasing incidence. Polysomonography (PSG) is the gold standard test in OSAHS diagnosis. Apnea-hypopnea index (AHI) is the main parameter of PSG, which is correlated with OSAHS severity. The main complaint of OSAHS patients is daytime sleepiness and the Epworth Sleepiness Scale (ESS) used for evaluation of disease severity. The correlation of AHI with daytime sleepiness and ESS is well known. But there are many patients, which have uncorrelated daytime sleepiness with AHI. This data calls this hypothesis; Are there any other parameters which may affect daytime sleepiness. 648 patients with complaining of snoring and apnea were evaluated by polysomnography and anthropometric measurements. The cut-off value of ESS was accepted 10 as an indicator of severe daytime sleepiness. Patients were divided to groups with the aim of homogenization, according to AHI values. The patients with similar AHI values were analyzed according to their ESS scores. BMI and neck circumference were elevated in daytime sleepiness patients. The nocturnal hypoxemia markers; apnea number/index, maximum duration of apnea, at least SO2 concentration, duration of SO2 less than 90 % were much effected in the group of daytime sleepiness. Beside the fact that our research, AHI is not enough for predicting the daytime sleepiness; anthropometric measurements and the nocturnal hypoxemia markers should be evaluated.
Continuous Positive Airway Pressure Treatment can Unmask Periodic Limb Movements in Patients with Obstructive Sleep Apnea
Simone Barreto, Rogerio Santos-Silva* and Sergio Tufik and Lia Bittencourt Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo – UNIFESP, Brazi
Abstract:
To test the hypothesis that obstructive sleep apnea (OSA) can mask concurrent periodic limb movements during sleep (PLMS), which becomes evident or worsens after treatment with continuous positive airway pressure (CPAP), the present study investigated the frequency of PLMS during polysomnography (PSG) for OSA diagnoses and for CPAP titration in consecutive patients with OSA. A total of 142 consecutive patients (29 women and 113 men; mean age of 53±10 years; body mass index of 31±6 kg/m2 ) referred to PSG for OSA diagnostic (PSG1) and CPAP titration (PSG2) on two different nights were retrospectively evaluated. The frequency of patients with PLMS index>5 events per hour of sleep was 13 (9%) in PSG1 and 18 (13%) in PSG2. Only four patients had PLMS index>5 in both PSGs. A decrease of the PLMS index was observed in two of the four patients who sustained PLMS index>5 in PSG2 compared to PSG1. These findings showed that the CPAP treatment can unmask but not exacerbate PLMS in patients with OSA.