ArticleAmerican journal of respiratory and critical care medicine2008
Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas.
Article in American journal of respiratory and critical care medicine, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00005275 (The Sleep Heart Health Study), which is not on this map. Cited by 121 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Sleep Heart Health Study (SHHS) Was a Multi-site Prospective Cohort Study to Investigate Obstructive Sleep Apnea (OSA) and Other Sleep-disordered Breathing (SDB) as Risk Factors for Cardiovascular Diseases and Hypertension
Who cites it
121 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- The prevalence of obstructive sleep apnea-hypopnea syndrome in patients with multiple sclerosis: a systematic review and meta-analysis.Frontiers in neurology · 2024Pooled it
- A systematic review on the association of sleep-disordered breathing with cardiovascular pathology in adults.NPJ primary care respiratory medicine · 2022Pooled it
- Snoring increases the development of coronary artery disease: a systematic review with meta-analysis of observational studies.Sleep & breathing = Schlaf & Atmung · 2021Pooled it
- Effect of Varying Definitions of Hypopnea on the Diagnosis and Clinical Outcomes of Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2019Pooled it
- Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis.BMJ open · 2017Pooled it
- Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2012Guideline
- Hypoxaemic burden in heart failure patients receiving adaptive servo-ventilation.ESC heart failure · 2023Trial
- Trial
- Increased platelet activation in sleep apnea subjects with intermittent hypoxemia.Sleep & breathing = Schlaf & Atmung · 2020Trial
- The influence of sleep apnea syndrome and intermittent hypoxia in carotid adventitial vasa vasorum.PloS one · 2019Trial
- Trial
- Trial
- Correlation of hypoxic burden with blood pressure diurnal rhythm in obstructive sleep apnea.Sleep · 2026Article
- Differential correlation patterns of serum prolactin and total antioxidant status in obstructive sleep apnea: A cross-sectional study.Medicine · 2026Article
- Differential associations of arousals and respiratory events on oxygen desaturation and resaturation parameters in sleep.Sleep & breathing = Schlaf & Atmung · 2026Article
- Smartwatch-based detection of moderate-to-severe and high-risk obstructive sleep apnea.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2026Observational
- Characterizing early response and adherence to hypoglossal nerve stimulation: real-world evidence from a single-center cohort.Sleep & breathing = Schlaf & Atmung · 2026Article
- Redefining Obstructive Sleep Apnea: Multidimensional Phenotyping Beyond the Apnea-Hypopnea Index.Pathophysiology : the official journal of the International Society for Pathophysiology · 2026Review
- Association of Obstructive Sleep Apnea and Nocturnal Hypoxemia With the Circadian Rhythm of Myocardial Infarction.Journal of the American Heart Association · 2025Observational
- Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2025Article
61 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
rationaleEpidemiologic studies on the consequences of sleep-disordered breathing invariably use the apnea-hypopnea index as the primary measure of disease severity. Although hypopneas constitute a majority of disordered breathing events, significant controversy remains about the best criteria used to define these events.
objectivesThe current investigation sought to assess the most appropriate definition for hypopneas that would be best correlated with cardiovascular disease.
methodsA community sample of middle-aged and older adults was recruited as part of the Sleep Heart Health Study. Full-montage polysomnography was conducted and hypopneas were defined using different thresholds of oxyhemoglobin desaturation with and without arousals. Prevalent cardiovascular disease was assessed based on self-report. Logistic regression analysis was used to characterize the independent association between the hypopnea index and prevalent cardiovascular disease. MEASUREMENTS AND MAIN
resultsUsing a sample of 6,106 adults with complete data on cardiovascular disease status and polysomnography, the current study found that hypopneas associated with an oxyhemoglobin desaturation of 4% or more were associated with prevalent cardiovascular disease independent of confounding covariates. The adjusted prevalent odds ratios for quartiles of the hypopnea index using a 4% desaturation criterion were as follows: 1.00 (<1.10 events/h), 1.10 (1.01-3.20 events/h), 1.33 (3.21-7.69 events/h), and 1.41 (>7.69 events/h). Hypopnea measures based on less than 4% oxyhemoglobin desaturation or presence of arousals showed no association with cardiovascular disease.
conclusionsHypopneas comprise a significant component of sleep-disordered breathing in the general community. By varying the criteria for defining hypopneas, this study demonstrates that hypopneas with a desaturation of at least 4% are independently associated with cardiovascular disease. In contrast, no association was observed between cardiovascular disease and hypopneas associated with milder desaturations or arousals.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.