The study’s rationale and design have been published elsewhere ( 8). This study analyzed data obtained from the Sleep Heart Health Study (SHHS) which was a prospective multicenter cohort study designed to investigate the relationship between OSA and cardiovascular diseases in the United States. We hypothesized that increasing OSA severity represented by the AHI3%A would be associated with a greater likelihood of having prevalent CVD or CHD, and that persons who were not identified as having OSA using the AHI4% criteria would have a higher likelihood as well. In addition, we sought to ascertain whether there was an association between CVD or CHD and OSA severity among individuals who were not identified as having OSA using the more restrictive standard of requiring at least a 4% oxygen desaturation irrespective of an arousal (AHI4%), but were classified as having OSA by the AHI3%A definition. Using the database from the Sleep Heart Health Study, a large well- characterized community based cohort that had undergone polysomnography, the current study aimed to determine the association between the AASM recommended definition of the AHI which incorporates hypopneas with at least a 3% desaturation or an arousal (AHI3%A) and self-reported CVD and coronary heart disease (CHD) in middle- aged and older adults. Therefore, determining if there is relationship between OSA characterized by at least 3% drop in saturation or an arousal from sleep and CVD may assist in identification of persons at risk for CVD, allow greater access to care and potentially improve other health-related outcomes. This reluctance to adopt a more inclusive definition of sleep apnea has restricted access to OSA treatment for many patients ( 7). The resistance to universal acceptance of the AASM criteria is based in part on the lack of evidence that 3% desaturations or arousals have an adverse cardiovascular impact. However, several payors including the Centers for Medicare and Medicaid Services (CMS) continue to require a more stringent hypopnea definition necessitating a 4% or greater decrease in oxygen saturation ( 5) despite evidence documenting a relationship between the AASM recommended standard and daytime sleepiness ( 6). In 2012, the American Academy of Sleep Medicine (AASM) recommended that the hypopnea definition include any decrease in airflow by at least 30% from the baseline with an oxyhemoglobin desaturation of at least 3%, or an arousal from sleep ( 4). However, there is controversy regarding the definition of the AHI. The most commonly used metric of OSA severity is the apnea hypopnea index (AHI). A number of large studies have established that OSA is a risk factor for the development of hypertension and cardiovascular disease (CVD) as well as higher mortality individuals with more severe OSA are at greater risk ( 1- 3). Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of either complete upper airway collapse (apneas) or partial collapse (hypopneas) during sleep.
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