Clinical, polysomnographic, and cephalometric features of obstructive sleep apnea with AHI over 100

Naoko Sata; Ayako Inoshita; Shoko Suda; Satomi Shiota; Nanako Shiroshita; Fusae Kawana; Yo Suzuki; Fumihiko Matsumoto; Katsuhisa Ikeda; Takatoshi Kasai

doi:10.1007/s11325-020-02241-8

Clinical, polysomnographic, and cephalometric features of obstructive sleep apnea with AHI over 100

Sleep Breath. 2021 Sep;25(3):1379-1387. doi: 10.1007/s11325-020-02241-8. Epub 2020 Nov 17.

Authors

Naoko Sata^{1

2}, Ayako Inoshita^{3

4}, Shoko Suda^{1

5}, Satomi Shiota^{1

6}, Nanako Shiroshita⁷, Fusae Kawana⁷, Yo Suzuki^{1

2}, Fumihiko Matsumoto², Katsuhisa Ikeda², Takatoshi Kasai^{1

5

7}

Affiliations

¹ Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.
² Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan.
³ Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan. ayaent@juntendo.ac.jp.
⁴ Department of Otolaryngology, Head and Neck surgery, Juntendo University Hospital, Bunkyo-ku Hongo 3-1-1, Tokyo, Japan. ayaent@juntendo.ac.jp.
⁵ Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
⁶ Department of Respiratory Medicine, Juntendo University Hospital, Tokyo, Japan.
⁷ Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

PMID: 33201370
DOI: 10.1007/s11325-020-02241-8

Abstract

Purpose: Obstructive sleep apnea (OSA) is induced by a sleep-related collapse of the upper airway in association with multiple factors. The severity of OSA is determined by the apnea-hypopnea index (AHI). Although obesity and sex differences are common factors in OSA, the level of the AHI varies to the same degree according to the age and sex and degree of obesity. However, only a few studies have evaluated AHI over 100/h, those reports did not describe why they set the AHI cutoff at 100/h. The purpose of this study was to elucidate the pathogenesis of "very" severe OSA, defined as having an AHI > 100/h.

Methods: AHI > 100/h was set as very severe OSA (VS-OSA) in this study. As controls, moderate to severe OSA patients, matched with VS-OSA for age, sex, and body mass index (BMI), were enrolled. The findings of polysomnography and cephalography between VS-OSA and controls were compared.

Results: Eleven patients in the VS-OSA group (mean AHI 110.2/h) and 22 patients in the control group (mean AHI 41.6/h) were compared (mean age 50.2 vs 50.6, male:female 5:6 vs 10:12, mean BMI 35.4 kg/m² vs 34.5 kg/m²). There were no significant differences in the clinical characteristics. In the polysomnographic parameters, the VS-OSA group showed apnea predominance, the mean percutaneous oxygen saturation (SO₂) was significantly lower in all sleep stages, and the minimum SO₂ was significantly lower (49.0% vs 77.5%, p = 0.002). A similar apnea duration and rather shorter hypopnea duration were shown. The time of apnea-to-arousal was significantly earlier (- 0.1 s vs 0.9 s, p = 0.003). Lung-to-finger circulation time showed no differences. The cephalometric findings showed no significant differences.

Conclusions: VS-OSA patients were more likely to have apnea predominance, desaturation when sleeping despite a similar apnea duration, and rather shorter hypopnea duration, and arousals were evoked significantly earlier.

Keywords: Apnea predominance; Arousal timing; Cephalography upper airway; Desaturation; Very severe obstructive sleep apnea.

MeSH terms

Adult
Cephalometry
Female
Humans
Male
Middle Aged
Polysomnography
Sleep Apnea, Obstructive / physiopathology*