Hypopnea scoring initiative: Current activities and future plans

The AASM Hypopnea Scoring Rule Task Force was commissioned by the AASM board of directors to create strategies for the adoption and implementation of the AASM Scoring Manual RECOMMENDED adult hypopnea scoring rule (≥3% oxygen desaturation or arousal)¹ among all members, sleep facilities, payers and device manufacturers (with the ≥4% oxygen desaturation hypopnea scoring rule [CMS criteria] being OPTIONAL). This recommendation is a follow-up to the AASM position statement recommending arousal-based scoring be used in the evaluation of sleep-disordered breathing in all patients.²

The task force developed a survey that was sent to all AASM-accredited sleep facilities to determine which centers are not using the RECOMMENDED hypopnea scoring criteria or any arousal-based scoring criteria as recommended by the recent AASM position statement. Although the  position statement and AASM Scoring Manual recommend scoring hypopneas using 3% oxygen desaturation or arousals, of the 512 facilities that completed the survey, half of them report scoring hypopneas only based on ≥4% oxygen desaturation. The results also show that 27% of surveyed facilities score hypopneas using both definitions to report AHI. Of those facilities that score multiple indices for in-laboratory PSG (e.g., 3% or arousal AHI, 4% AHI,  3% RDI, 4% RDI [RDI includes RERA index]), only 11% indicated that scoring with both rules results in significant work. The task force is also assessing the impact of scoring hypopneas using both definitions with respect to the added technologist time burden. It appears that a significant number of PSG software programs can score hypopneas using multiple definitions with minimal, if any, time impact. Although sleep facilities would not be required to score using both scoring rules, in certain patients, both may need to be scored.

Finally, a series of virtual meetings with thought leaders in sleep medicine and sleep research will be scheduled to discuss the clinical impact of requiring the RECOMMENDED hypopnea definition be used, review the evidence supporting a more inclusive definition of hypopneas, and propose research topics for grant opportunities that would provide support for the use of the RECOMMENDED hypopnea definition.

For inquiries or suggestions, please contact scoring@aasm.org.

2020 – 2021 Hypopnea Scoring Rule Task Force

Richard B. Berry, MD (Chair); Alexandre Abreu, MD; Vidya Krishnan, MD; Stuart Quan, MD; Patrick Strollo, Jr., MD; Jeremy Weingarten, MD; Raman Malhotra, MD (Board Liaison)

References

1. Berry RB, Quan SF, Abreu AR, et al.; for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.6. Darien, IL: American Academy of Sleep Medicine; 2020.

2. Malhotra RK, Kirsch DB, Kristo DA, Olson EJ, Aurora RN, Carden KA, Chervin RD, Martin JL, Ramar K, Rosen CL, Rowley JA, Rosen IM; American Academy of Sleep Medicine Board of Directors. Polysomnography for obstructive sleep apnea should include arousal-based scoring: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2018;14(7):1245–1247. https://doi.org/10.5664/jcsm.7234