Effect of Varying Definitions of Hypopnea on the Diagnosis and Clinical Outcomes of Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

STUDY OBJECTIVES: Various criteria have been used for scoring hypopneas, leading to difficulties when comparing results in clinical and research settings. We conducted a systematic review and meta-analysis to assess the effect of different hypopnea definitions on the diagnosis, severity, and clinical implications of sleep-disordered breathing (SDB). METHODS: Ovid MEDLINE, Embase, and Scopus databases were queried for English-language publications from inception through March 7, 2017. Studies that directly compared various hypopnea definitions were eligible. The hierarchical summary receiver operating characteristic model was used to jointly estimate diagnostic performance for comparisons between criteria. RESULTS: The initial search yielded 2,828 abstracts; 28 met inclusion criteria. After reviewing reference lists and expert review, five additional articles were identified. Most of the studies were cross-sectional or retrospective in nature. Eleven studies compared 2007 recommended criteria with 2012 criteria; 6 of these (evaluating 6,628 patients) were suitable for inclusion in the meta-analysis. Using the 2012 definition (≥ 3% desaturation or arousal) as the reference standard, the 2007 definition (≥ 4% desaturation) showed a sensitivity of 82.7% (95% confidence interval 0.72-0.90) and specificity of 93.2% (95% confidence interval 0.82-0.98). Although 2007 criteria were found to be associated with prevalent cardiovascular (CV) disease and increased risk of CV death, the 2012 criteria appeared to correspond better with intermediate CV risk markers based on two abstracts. CONCLUSIONS: As expected, 2012 hypopnea scoring criteria resulted in a greater prevalence and severity of SDB. Data regarding the effect of varying hypopnea definitions on clinical outcomes, quality of life, health care costs, and mortality rates are limited. COMMENTARY: A commentary on this article appears in this issue on page 683.

Original languageEnglish (US)
Pages (from-to)687-696
Number of pages10
JournalJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Volume15
Issue number5
DOIs
StatePublished - May 15 2019

Fingerprint

Sleep Apnea Syndromes
Meta-Analysis
Confidence Intervals
Quality of Health Care
Arousal
MEDLINE
ROC Curve
Health Care Costs
Publications
Cardiovascular Diseases
Language
Cross-Sectional Studies
Quality of Life
Databases
Mortality
Research

Keywords

  • health care costs
  • hypopnea
  • prevalence
  • ROC curve
  • sensitivity and specificity
  • sleep apnea syndromes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

@article{a798c8cca41f44358f47026b576f078f,
title = "Effect of Varying Definitions of Hypopnea on the Diagnosis and Clinical Outcomes of Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis",
abstract = "STUDY OBJECTIVES: Various criteria have been used for scoring hypopneas, leading to difficulties when comparing results in clinical and research settings. We conducted a systematic review and meta-analysis to assess the effect of different hypopnea definitions on the diagnosis, severity, and clinical implications of sleep-disordered breathing (SDB). METHODS: Ovid MEDLINE, Embase, and Scopus databases were queried for English-language publications from inception through March 7, 2017. Studies that directly compared various hypopnea definitions were eligible. The hierarchical summary receiver operating characteristic model was used to jointly estimate diagnostic performance for comparisons between criteria. RESULTS: The initial search yielded 2,828 abstracts; 28 met inclusion criteria. After reviewing reference lists and expert review, five additional articles were identified. Most of the studies were cross-sectional or retrospective in nature. Eleven studies compared 2007 recommended criteria with 2012 criteria; 6 of these (evaluating 6,628 patients) were suitable for inclusion in the meta-analysis. Using the 2012 definition (≥ 3{\%} desaturation or arousal) as the reference standard, the 2007 definition (≥ 4{\%} desaturation) showed a sensitivity of 82.7{\%} (95{\%} confidence interval 0.72-0.90) and specificity of 93.2{\%} (95{\%} confidence interval 0.82-0.98). Although 2007 criteria were found to be associated with prevalent cardiovascular (CV) disease and increased risk of CV death, the 2012 criteria appeared to correspond better with intermediate CV risk markers based on two abstracts. CONCLUSIONS: As expected, 2012 hypopnea scoring criteria resulted in a greater prevalence and severity of SDB. Data regarding the effect of varying hypopnea definitions on clinical outcomes, quality of life, health care costs, and mortality rates are limited. COMMENTARY: A commentary on this article appears in this issue on page 683.",
keywords = "health care costs, hypopnea, prevalence, ROC curve, sensitivity and specificity, sleep apnea syndromes",
author = "Meghna Mansukhani and Kolla, {Bhanu Prakash} and Zhen Wang and Morgenthaler, {Timothy Ian}",
year = "2019",
month = "5",
day = "15",
doi = "10.5664/jcsm.7750",
language = "English (US)",
volume = "15",
pages = "687--696",
journal = "Journal of Clinical Sleep Medicine",
issn = "1550-9389",
publisher = "American Academy of Sleep Medicine",
number = "5",

}

TY - JOUR

T1 - Effect of Varying Definitions of Hypopnea on the Diagnosis and Clinical Outcomes of Sleep-Disordered Breathing

T2 - A Systematic Review and Meta-Analysis

AU - Mansukhani, Meghna

AU - Kolla, Bhanu Prakash

AU - Wang, Zhen

AU - Morgenthaler, Timothy Ian

PY - 2019/5/15

Y1 - 2019/5/15

N2 - STUDY OBJECTIVES: Various criteria have been used for scoring hypopneas, leading to difficulties when comparing results in clinical and research settings. We conducted a systematic review and meta-analysis to assess the effect of different hypopnea definitions on the diagnosis, severity, and clinical implications of sleep-disordered breathing (SDB). METHODS: Ovid MEDLINE, Embase, and Scopus databases were queried for English-language publications from inception through March 7, 2017. Studies that directly compared various hypopnea definitions were eligible. The hierarchical summary receiver operating characteristic model was used to jointly estimate diagnostic performance for comparisons between criteria. RESULTS: The initial search yielded 2,828 abstracts; 28 met inclusion criteria. After reviewing reference lists and expert review, five additional articles were identified. Most of the studies were cross-sectional or retrospective in nature. Eleven studies compared 2007 recommended criteria with 2012 criteria; 6 of these (evaluating 6,628 patients) were suitable for inclusion in the meta-analysis. Using the 2012 definition (≥ 3% desaturation or arousal) as the reference standard, the 2007 definition (≥ 4% desaturation) showed a sensitivity of 82.7% (95% confidence interval 0.72-0.90) and specificity of 93.2% (95% confidence interval 0.82-0.98). Although 2007 criteria were found to be associated with prevalent cardiovascular (CV) disease and increased risk of CV death, the 2012 criteria appeared to correspond better with intermediate CV risk markers based on two abstracts. CONCLUSIONS: As expected, 2012 hypopnea scoring criteria resulted in a greater prevalence and severity of SDB. Data regarding the effect of varying hypopnea definitions on clinical outcomes, quality of life, health care costs, and mortality rates are limited. COMMENTARY: A commentary on this article appears in this issue on page 683.

AB - STUDY OBJECTIVES: Various criteria have been used for scoring hypopneas, leading to difficulties when comparing results in clinical and research settings. We conducted a systematic review and meta-analysis to assess the effect of different hypopnea definitions on the diagnosis, severity, and clinical implications of sleep-disordered breathing (SDB). METHODS: Ovid MEDLINE, Embase, and Scopus databases were queried for English-language publications from inception through March 7, 2017. Studies that directly compared various hypopnea definitions were eligible. The hierarchical summary receiver operating characteristic model was used to jointly estimate diagnostic performance for comparisons between criteria. RESULTS: The initial search yielded 2,828 abstracts; 28 met inclusion criteria. After reviewing reference lists and expert review, five additional articles were identified. Most of the studies were cross-sectional or retrospective in nature. Eleven studies compared 2007 recommended criteria with 2012 criteria; 6 of these (evaluating 6,628 patients) were suitable for inclusion in the meta-analysis. Using the 2012 definition (≥ 3% desaturation or arousal) as the reference standard, the 2007 definition (≥ 4% desaturation) showed a sensitivity of 82.7% (95% confidence interval 0.72-0.90) and specificity of 93.2% (95% confidence interval 0.82-0.98). Although 2007 criteria were found to be associated with prevalent cardiovascular (CV) disease and increased risk of CV death, the 2012 criteria appeared to correspond better with intermediate CV risk markers based on two abstracts. CONCLUSIONS: As expected, 2012 hypopnea scoring criteria resulted in a greater prevalence and severity of SDB. Data regarding the effect of varying hypopnea definitions on clinical outcomes, quality of life, health care costs, and mortality rates are limited. COMMENTARY: A commentary on this article appears in this issue on page 683.

KW - health care costs

KW - hypopnea

KW - prevalence

KW - ROC curve

KW - sensitivity and specificity

KW - sleep apnea syndromes

UR - http://www.scopus.com/inward/record.url?scp=85066351640&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066351640&partnerID=8YFLogxK

U2 - 10.5664/jcsm.7750

DO - 10.5664/jcsm.7750

M3 - Article

C2 - 31053203

AN - SCOPUS:85066351640

VL - 15

SP - 687

EP - 696

JO - Journal of Clinical Sleep Medicine

JF - Journal of Clinical Sleep Medicine

SN - 1550-9389

IS - 5

ER -