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Study Objectives: <p>A decrease in rapid eye movement (REM) time during polysomnography in patients with obstructive sleep apnea (OSA) can result in underestimation of apnea-hypopnea index (AHI). We propose adjusting AHI to normalized REM% in individuals with REM% ≤ 15% to avoid underdiagnosis of OSA.</p> Methods: <p>All children who completed diagnostic polysomnography from 2016–2023 with REM% of ≤ 15% of total sleep time were selected for adjustment. AHI adjustment was done by multiplying AHI by a normalization factor (20%)/REM%. Changes in OSA diagnosis and severity were evaluated before vs after adjustment. Intraclass comparison and Bland-Altman plots were used to evaluate agreement level of adjusted AHI vs nonadjusted AHI with REM AHI as the reference. <i>P</i> value &lt; .05 was significant.</p> Results: <p>Of 389 children reviewed, only 79 (20%) children had low REM% of ≤ 15%. Median (range) age was 12.8 (0.9–18) years with male/female ratio 2.3/1. Mean (standard deviation) sleep efficiency was 64.7% (12.3). Mean (standard deviation) REM% was 10.5% (3.4). Median AHI (range) before AHI adjustment was 1.7 (0–44) events/h vs 4.1 (0–74.4) events/h after AHI adjustment (<i>P</i> &lt; .001). Adjusted AHI had better agreement with REM-AHI (intraclass correlation = .691; 95% confidence interval: 0.58, 0.80) than nonadjusted AHI (intraclass correlation = .485; 95% confidence interval: 0.39, 0.58). AHI adjustment changed diagnosis from normal to mild OSA in 12 (15%) patients, from mild to moderate OSA in 7 (9%) patients, and from moderate to severe OSA in 9 (11%) patients (<i>P</i> = .044).</p> Conclusions: <p>Adjusting AHI in patients with low REM% to a normalized REM% can help avoid underdiagnosis of OSA and/or underestimation of its severity.</p> Citation: <p>Alnaimi A, Toma H, Abushahin A, Belavendra A, Abu-Hasan M. Adjusting the apnea-hypopnea index in children with a low percentage of REM sleep and its potential impact on OSA diagnosis and severity. <i>J Clin Sleep Med</i>. 2025;21(5):783–788.</p>

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Adjusting the apnea-hypopnea index in children with a low percentage of REM sleep and its potential impact on OSA diagnosis and severity

  • 期刊论文

  • 发表日期：

    2025年5月1日

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  • Amal Alnaimi,
  • Haneen Toma,
  • Ahmed Abushahin,
  • Antonisamy Belavendra,
  • Mutasim Abu-Hasan

摘要

Study Objectives:

A decrease in rapid eye movement (REM) time during polysomnography in patients with obstructive sleep apnea (OSA) can result in underestimation of apnea-hypopnea index (AHI). We propose adjusting AHI to normalized REM% in individuals with REM% ≤ 15% to avoid underdiagnosis of OSA.

Methods:

All children who completed diagnostic polysomnography from 2016–2023 with REM% of ≤ 15% of total sleep time were selected for adjustment. AHI adjustment was done by multiplying AHI by a normalization factor (20%)/REM%. Changes in OSA diagnosis and severity were evaluated before vs after adjustment. Intraclass comparison and Bland-Altman plots were used to evaluate agreement level of adjusted AHI vs nonadjusted AHI with REM AHI as the reference. P value < .05 was significant.

Results:

Of 389 children reviewed, only 79 (20%) children had low REM% of ≤ 15%. Median (range) age was 12.8 (0.9–18) years with male/female ratio 2.3/1. Mean (standard deviation) sleep efficiency was 64.7% (12.3). Mean (standard deviation) REM% was 10.5% (3.4). Median AHI (range) before AHI adjustment was 1.7 (0–44) events/h vs 4.1 (0–74.4) events/h after AHI adjustment (P < .001). Adjusted AHI had better agreement with REM-AHI (intraclass correlation = .691; 95% confidence interval: 0.58, 0.80) than nonadjusted AHI (intraclass correlation = .485; 95% confidence interval: 0.39, 0.58). AHI adjustment changed diagnosis from normal to mild OSA in 12 (15%) patients, from mild to moderate OSA in 7 (9%) patients, and from moderate to severe OSA in 9 (11%) patients (P = .044).

Conclusions:

Adjusting AHI in patients with low REM% to a normalized REM% can help avoid underdiagnosis of OSA and/or underestimation of its severity.

Citation:

Alnaimi A, Toma H, Abushahin A, Belavendra A, Abu-Hasan M. Adjusting the apnea-hypopnea index in children with a low percentage of REM sleep and its potential impact on OSA diagnosis and severity. J Clin Sleep Med. 2025;21(5):783–788.