The 2012 AASM Respiratory Event Criteria Increase the Incidence of Hypopneas in an Adult Sleep Center Population
Open accessAbstract
Study objectives To investigate the effect of the 2012 American Academy of Sleep Medicine (AASM) respiratory event criteria on severity and prevalence of obstructive sleep apnea (OSA) relative to previous respiratory event criteria. Methods A retrospective, randomized comparison was conducted in an Australian clinical sleep laboratory in a tertiary hospital. The polysomnograms (PSG) of 112 consecutive patients undertaking polysomnography (PSG) for suspected OSA were re-scored for respiratory events using either 2007 AASM recommended (AASM2007Rec), 2007 AASM alternate (AASM2007Alt), Chicago criteria (AASM1999), or 2012 AASM recommended (AASM2012) respiratory event criteria. Results The median AHI using AASM2012 was approximately 90% greater than the AASM2007Rec AHI, approximately 25% greater than the AASM2007Alt AHI, and approximately 15% lower than the AASM1999 AHI. These changes increased OSA diagnoses by approximately 20% and 5% for AASM2007Rec and AASM2007Alt, respectively. Minimal changes in OSA diagnoses were observed between AASM1999 and AASM2012 criteria. To achieve the same OSA prevalence as AASM2012, the threshold for previous criteria would have to shift to 2.6/h, 3.6/h, and 7.3/h for AASM2007Rec, AASM2007Alt, and AASM1999, respectively. Differences between the AASM2007Rec and AASM2012 hypopnea indices (HI) were predominantly due to the change in desaturation levels required. Alterations to respiratory event duration rules had no effect on the HI. Conclusions This study demonstrates that implementation of the 2012 AASM respiratory event criteria will increase the AHI in patients undergoing PSG, and more patients are likely to be diagnosed with OSA. Commentary A commentary on this article appears in this issue on page 1357.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Depending on which hypopnea definition is used, the AHI may be considerably different in a given individual.
“Depending on which definition is used, the AHI may be considerably different in a given individual.25–27”
From Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline (2017) · cites this paper as [27]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
Martin Bland, J., & Altman, D. (1986) · The Lancet · doi:10.1016/s0140-6736(86)90837-8 · Cited by 47,965 · see citing works
Passing, H., & Bablok, W. (1983) · cclm · doi:10.1515/cclm.1983.21.11.709 · Cited by 1,513 · see citing works
The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index
Ruehland, W. R., Rochford, P. D., O’Donoghue, F. J., Pierce, R. J., Singh, P., & Thornton, A. T. (2009) · SLEEP · doi:10.1093/sleep/32.2.150 · Cited by 696 · see citing works
Flagged first, then by citations
Research works printed but not linked: 16
- [1]American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89. [PubMed] [Google Scholar]
- [2]Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28:499–521. doi: 10.1093/sleep/28.4.499. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
- [3]Iber C, Ancoli-Israel S, Chesson AL, Quan S. 1st ed. Westchester, IL: American Academy of Sleep Medicine; 2007. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specification. [Google Scholar]
- [4]Grigg-Damberger MM. The AASM scoring manual: a critical appraisal. Curr Opin Pulm Med. 2009;15:540–49. doi: 10.1097/MCP.0b013e328331a2bf. [DOI] [PubMed] [Google Scholar] · DOI
- [7]Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012;8:597–619. doi: 10.5664/jcsm.2172. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
- [8]BaHammam A, Obeidat A, Barataman K, et al. A comparison between the AASM 2012 and 2007 definitions for detecting hypopnea. Sleep Breath. 2014;18:767–73. doi: 10.1007/s11325-014-0939-3. [DOI] [PubMed] [Google Scholar] · DOI
- [10]D'Agostino RB, Pearson ES. Tests for departure from normality. Empirical results for the Distributions of b2 and √ b1. Biometrika. 1973;60:613–22. [Google Scholar]
- [11]Dunn OJ. Multiple comparisons among means. J Am Stat Assoc. 1961;56:54–64. [Google Scholar]
- [13]Olive DJ. Prediction intervals for regression models. Comput Stat Data Anal. 2007;51:3115–22. [Google Scholar]
- [15]Kroll MH, Emancipator K. A theoretical evaluation of linearity. Clin Chem. 1993;39:405–13. [PubMed] [Google Scholar]
- [16]Ward NR, Roldao V, Cowie MR, et al. The effect of respiratory scoring on the diagnosis and classification of sleep disordered breathing in chronic heart failure. Sleep. 2013;36:1341–8. doi: 10.5665/sleep.2960. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
- [17]American Academy of Sleep Medicine. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014. International classification of sleep disorders. [Google Scholar]
- [18]Albarrak M, Banno K, Sabbagh AA, et al. Utilization of healthcare resources in obstructive sleep apnea syndrome: a 5-year follow-up study in men using CPAP. Sleep. 2005;28:1306–11. doi: 10.1093/sleep/28.10.1306. [DOI] [PubMed] [Google Scholar] · DOI
- [19]Loredo JS, Clausen JL, Ancoli-Israel S, et al. Night-to-night arousal variability and interscorer reliability of arousal measurements. Sleep. 1999;22:916–20. doi: 10.1093/sleep/22.7.916. [DOI] [PubMed] [Google Scholar] · DOI
- [20]Duce B, Rego C, Milosavljevic J, et al. The AASM recommended and acceptable EEG montages are comparable for the staging of sleep and scoring of EEG arousals. J Clin Sleep Med. 2014;10:803–9. doi: 10.5664/jcsm.3880. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
- [21]Guilleminault C, Hagen CC, Huynh NT. Comparison of hypopnea definitions in lean patients with known obstructive sleep apnea hypopnea syndrome (OSAHS) Sleep Breath. 2009;13:341–7. doi: 10.1007/s11325-009-0253-7. [DOI] [PubMed] [Google Scholar] · DOI
Cited by
Sorted by citations
Benjafield, A. V., Ayas, N. T., Eastwood, P. R., Heinzer, R., Ip, M. S. M., Morrell, M. J., Nunez, C. M., Patel, S. R., Penzel, T., Pépin, J.-L., et al. (2019) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(19)30198-5 · Cited by 4,326 · see citing works
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6506 · Cited by 3,253 · see citing works
Liu, L., Su, G., Wang, S., & Zhu, B. (2019) · Sleep and Breathing · doi:10.1007/s11325-018-1714-7 · Cited by 124 · see citing works
Wimms, A. J., Kelly, J. L., Turnbull, C. D., McMillan, A., Craig, S. E., O'Reilly, J. F., Nickol, A. H., Hedley, E. L., Decker, M. D., Willes, L. A., et al. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(19)30402-3 · Cited by 95 · see citing works
Hirotsu, C., Haba-Rubio, J., Andries, D., Tobback, N., Marques-Vidal, P., Vollenweider, P., Waeber, G., & Heinzer, R. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7612 · Cited by 63 · see citing works
Mansukhani, M. P., Kolla, B. P., Wang, Z., & Morgenthaler, T. I. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7750 · Cited by 51 · see citing works
Hsu, Y.-S., Chen, T.-Y., Wu, D., Lin, C.-M., Juang, J.-N., & Liu, W.-T. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8462 · Cited by 40 · see citing works
Pataka, A., Kalamaras, G., Vlachogianni, E., & Argyropoulou, P. (2019) · Pulmonology · doi:10.1016/j.pulmoe.2018.10.004 · Cited by 12 · see citing works
Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea
Jung, S. Y., Rhee, E. H., Al‐Dilaijan, K. F., Kim, S. W., & Min, J. (2020) · The Laryngoscope · doi:10.1002/lary.28019 · Cited by 8 · see citing works
- Authors
- Duce, B., Milosavljevic, J., & Hukins, C.
- Affiliations
- Queensland University of Technology (AU)
- Princess Alexandra Hospital (AU)
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2015-12-15
- Volume
- 11
- Issue
- 12
- Pages
- 1425-1431
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC4661335
- OpenAlex
- W1915855125
- Cited by
- 120
- References
- 3
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 14 · 2023: 15 · 2022: 11 · 2021: 9 · 2020: 12 · 2019: 16 · 2018: 13 · 2017: 5 · 2016: 9 · 2015: 1
- FWCI
- 6.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Institute of Health and Biomedical Innovation; Science & Engineering Faculty
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- obstructive sleep apnea, hypopnea, apnea-hypopnea index, hypopnea index, sleep apnea diagnosis, polysomnography scoring, sleep laboratory
- MeSH terms
- Academies and Institutes, Adult, Aged, Australia, Female, Humans, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, United States, Incidence, Prevalence, Polysomnography, Sleep Apnea, Obstructive, Sleep Medicine Specialty
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
