Impact of AASM 2012 Recommended Hypopnea Criteria on Surgical Outcomes for Obstructive Sleep Apnea

Abstract

Objectives To assess the impact of the American Academy of Sleep Medicine (AASM)( 2012Rec) criteria on the surgical success rate and polysomnography (PSG) parameters of patients with obstructive sleep apnea (OSA). Study Design A prospective clinical trial. Methods A total of 60 patients who performed surgery for treatment of OSA at the sleep breathing disorder center of a tertiary referral university hospital from October 1, 2015, to September 30, 2016, were enrolled. Preoperative and postoperative PSG were performed and scored using AASM( 2007Rec) and AASM( 2012Rec). Surgical success was determined by criteria 1 (postoperative Apnea-Hypopnea Index [AHI] <20% and 50% reduction) and criteria 2 (postoperative AHI <10), and surgical success rates according to AASM( 2007Rec) and AASM( 2012Rec) were compared. Results PSG parameters including AHI, hypopnea index, respiratory effort-related arousals, respiratory disturbance index, and supine AHI scored significantly higher with AASM( 2012Rec) compared to AASM( 2007Rec) criteria, both preoperatively and postoperatively (all P < 0.05). Furthermore, when compared to the AASM( 2007Rec) criteria, AASM( 2012Rec) resulted in increased proportion of patients with severe OSA (70.0% vs. 95.0%; P < 0.001). For the surgical outcomes, AASM( 2012Rec) showed significantly lower surgical success rate both in criteria 1 (51.7% vs. 38.3%) and criteria 2 (35.0% vs. 18.3%) compared to the AASM( 2007Rec), respectively (P < 0 .05). Conclusions This study demonstrated that AASM( 2012Rec) tends to decrease the success rate of surgical outcome for OSA patients, suggesting that defining success of surgical treatment for OSA could be changed dramatically according to the hypopnea scoring criteria. Level of Evidence 4 Laryngoscope, 130:825-831, 2020