Variability in the apnea-hypopnea index and its consequences for diagnosis and therapy evaluation.
BACKGROUND
The apnea-hypopnea index (AHI) is frequently used to recognize obstructive sleep apnea (OSA) and to evaluate therapy.


OBJECTIVE
The aim of this study was to determine the AHI variability during a 10-week period, and to discuss its consequences for diagnosis and therapy evaluation.


METHODS
Fifteen OSA patients (50.8 +/- 11.2 years) underwent four polysomnographic (PSG) recordings, with a mean interval between recordings of 3.3 weeks.


RESULTS
No differences were found in the average AHI values of the four PSG recordings (p = 0.985). Nevertheless, pooling all data of the 15 participants yielded a smallest detectable difference for AHI of 12.8. Linear regression between the individual means and standard deviations (SDs) of AHI showed that participants with a higher AHI tended to have a higher SD (p < 0.044).


CONCLUSIONS
These results suggest a considerable intra-individual variability in AHI recordings. Hence, a single-night recording can only recognize OSA when the AHI lies outside a cutoff band surrounding the AHI cutoff point. AHI variability should also be taken into account when evaluating OSA therapy. In this context, it should be noted that it is mainly the approach that we would like to convey to the reader and not the cutoff values per se.
Aarab
Ghizlane
G
Department of Oral Function, Academic Center for Dentistry Amsterdam, University of Amsterdam and Free University of Amsterdam, Louwesweg 1, Amsterdam, The Netherlands.
Lobbezoo
Frank
F
Hamburger
Hans L
HL
Naeije
Machiel
M
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy