ArticleJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2025
Adjusting the apnea-hypopnea index in children with a low percentage of REM sleep and its potential impact on OSA diagnosis and severity.
Article in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
STUDY
objectivesA 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.
methodsAll 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.
resultsOf 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 (
conclusionsAdjusting 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.
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