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Diagnosis obstructive sleep apnea

Diagnosis obstructive sleep apnea
Sleep testing device Index Diagnostic criteria for OSA
Polysomnography* AHI

AHI 5 to 14/hour sleep PLUS one or more sleep-associated conditions

or

AHI ≥15/hour sleep
RDI

RDI 5 to 14/hour sleep PLUS one or more sleep associated conditions

or

RDI ≥15/hour sleep
Home sleep apnea deviceΔ REI REI ≥15/hour total recording time
For the diagnosis of obstructive sleep apnea (OSA), respiratory events should be identified as primarily obstructive (ie, apneas, hypopneas, arousals that are associated with respiratory effort). These events are used to generate the following indices:
  • AHI: apnea-hypopnea index (apneas + hypopneas / total sleep time in hours)
  • RDI: respiratory disturbance index (apneas + hypopneas + respiratory effort-related arousals [RERAs] / total sleep time in hours)
  • REI: respiratory event index (apneas + hypopneas/total recording time)

* Most polysomnography studies will report AHI, RDI, or both values. The clinician should recognize that the RDI may overestimate or the AHI underestimate the number of respiratory events during sleep. However, no consensus has been reached regarding which value is more accurate.

¶ Sleep-associated conditions include the following:

  • Sleepiness, nonrestorative sleep, fatigue, or insomnia symptoms
  • Waking up with breath holding, gasping, or choking
  • Habitual snoring, breathing interruptions, or both noted by a bed partner or other observer
  • Hypertension, mood disorder, cognitive dysfunction, coronary artery disease, stroke, congestive heart failure, atrial fibrillation, or type 2 diabetes mellitus

Δ Home devices vary significantly in what data they collect. For example, type 3 and 4 devices do not typically detect arousals from sleep because they do not include electroencephalography (EEG) data. The clinician should be aware of the limitations of the device used.

Graphic 121160 Version 2.0