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Since the recognition that symptoms of excessive daytime somnolence, problems with concentration, mood and cognitive impairment, as well as cardiometabolic abnormalities can arise as a consequence of obstructed breathing during sleep, it has been subject to variation in its definition. Over the past five decades, attempts have been made to standardise the definitions and scoring criteria used for apnoeas and hypopnoea, which are the hallmarks of obstructive sleep apnoea (OSA). However, applying these definitions in clinical and research practice has resulted in over- and under-estimation of the severity and prevalence of OSAS. Furthermore, the definitions may eventually become redundant in the context of rapid technological advances in breathing measurement and other signal acquisition. Increased efforts towards precision medicine have led to a focus on the pathophysiology of obstructed breathing during sleep. However, the same degree of effort has not been focused on how and why the latter does or does not result in diurnal symptoms, integral to the definition of OSAS. This review focuses on OSAS in adults and discusses some of the difficulties with current definitions and the possible reasons behind them.<\/jats:p>","DOI":"10.1183\/20734735.0082-2021","type":"journal-article","created":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T08:30:50Z","timestamp":1630485050000},"page":"210082","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":40,"title":["Defining obstructive sleep apnoea syndrome: a failure of semantic rules"],"prefix":"10.1183","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8983-9985","authenticated-orcid":false,"given":"Renata L.","family":"Riha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"key":"2024101703583752000_17.3.210082.1","first-page":"1373","article-title":"Diagnostic approaches to respiratory sleep disorders","volume":"7","author":"Riha","year":"2015","journal-title":"J Thorac Dis"},{"key":"2024101703583752000_17.3.210082.2","doi-asserted-by":"crossref","first-page":"335","DOI":"10.5664\/jcsm.7640","article-title":"Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine clinical practice guideline","volume":"15","author":"Patil","year":"2019","journal-title":"J Clin Sleep Med"},{"key":"2024101703583752000_17.3.210082.3","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s40248-018-0157-0","article-title":"From CPAP to tailored therapy for obstructive sleep apnoea","volume":"13","author":"Sutherland","year":"2018","journal-title":"Multidiscip Respir Med"},{"key":"2024101703583752000_17.3.210082.4","doi-asserted-by":"crossref","first-page":"zsab030","DOI":"10.1093\/sleep\/zsab030","article-title":"Metrics of sleep apnea severity: beyond the AHI","volume":"44","author":"Malhotra","year":"2021","journal-title":"Sleep"},{"key":"2024101703583752000_17.3.210082.5","doi-asserted-by":"crossref","first-page":"e13066","DOI":"10.1111\/jsr.13066","article-title":"On the rise and fall of the apnea-hypopnea index: a historical review and critical appraisal","volume":"29","author":"Pevernagie","year":"2020","journal-title":"J Sleep Res"},{"key":"2024101703583752000_17.3.210082.6","unstructured":"American Academy of Sleep Medicine . 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