{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:24:31Z","timestamp":1787736271834,"version":"build-2784847793"},"reference-count":17,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>This study aimed to evaluate the agreement between apnea-hypopnea index (AHI)- and hypoxic burden (HB)-based obstructive sleep apnea (OSA) severity classifications. A retrospective single-center study of adults aged 18-79 years undergoing full-night in-laboratory polysomnography was conducted. OSA severity by AHI was categorized as normal (&lt;5 events\/hour), mild (5 to &lt;15), moderate (15 to &lt;30), or severe (\u226530). HB severity was categorized as mild (&lt;3.34), moderate (3.34 to 6.66), or severe (\u22656.67). Agreement among patients with OSA (AHI \u22655) was assessed using Cohen\u2019s kappa. Ninety-five patients were included (mean age 58.4\u00b118.3 years); 73 (76.8%) had OSA. Among these, HB severity exceeded AHI severity in 27.4%, was concordant in 61.6%, and was lower in 11.0%. Observed agreement was 30.1%, with slight concordance beyond chance (\u03ba=0.168, p&lt;0.001). Continuous AHI and HB were moderately correlated (r=0.663, p&lt;0.001). Patients with HB greater than AHI severity demonstrated significantly lower nadir oxygen saturation (p=0.011). AHI- and HB-based OSA severity classifications demonstrate limited agreement. Incorporation of HB may provide a more physiologically informative assessment of OSA severity beyond event frequency alone.<\/jats:p>","DOI":"10.4081\/monaldi.2026.4016","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:08:23Z","timestamp":1787735303000},"source":"Crossref","is-referenced-by-count":0,"title":["Agreement between apnea-hypopnea index and hypoxic burden for severity classification of obstructive sleep apnea"],"prefix":"10.4081","author":[{"given":"Muhammad","family":"Salik","sequence":"first","affiliation":[{"name":"Baptist Hospitals of Southeast Texas, Beaumont, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Saad","sequence":"additional","affiliation":[{"name":"Baptist Hospitals of Southeast Texas, Beaumont, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William S","family":"Burkes","sequence":"additional","affiliation":[{"name":"Baptist Hospitals of Southeast Texas, Beaumont, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"85697","doi-asserted-by":"crossref","unstructured":"Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 2019;7:687-98.","DOI":"10.1016\/S2213-2600(19)30198-5"},{"key":"85698","doi-asserted-by":"crossref","unstructured":"Tang Y, Li D, Yang M, et al. Prevalence of excessive daytime sleepiness (EDS) and its association with quality of life in patients with obstructive sleep apnea (OSA): data from a sleep-center in Shenzhen, a single-center cross-sectional study. J Thorac Dis 2024;16:8216-29.","DOI":"10.21037\/jtd-24-1322"},{"key":"85699","doi-asserted-by":"crossref","unstructured":"Quan SF, Chan CS, Dement WC, et al. The association between obstructive sleep apnea and neurocognitive performance--the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 2011;34:303-14B.","DOI":"10.1093\/sleep\/34.3.303"},{"key":"85700","doi-asserted-by":"crossref","unstructured":"Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive Sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2021;144:e56-67.","DOI":"10.1161\/CIR.0000000000000988"},{"key":"85701","doi-asserted-by":"crossref","unstructured":"Abbasi A, Gupta SS, Sabharwal N, et al. A comprehensive review of obstructive sleep apnea. Sleep Sci 2021;14:142-54.","DOI":"10.4103\/HMJ.HMJ_28_20"},{"key":"85702","doi-asserted-by":"crossref","unstructured":"Parekh A. Hypoxic burden - definitions, pathophysiological concepts, methods of evaluation, and clinical relevance. Curr Opin Pulm Med 2024;30:600-6.","DOI":"10.1097\/MCP.0000000000001122"},{"key":"85703","doi-asserted-by":"crossref","unstructured":"Borsini E, Nogueira F, Nigro C. Apnea-hypopnea index in sleep studies and the risk of over-simplification. Sleep Sci 2018;11:45-8.","DOI":"10.5935\/1984-0063.20180010"},{"key":"85704","doi-asserted-by":"crossref","unstructured":"Azarbarzin A, Sands SA, Stone KL, et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J 2019;40:1149-57.","DOI":"10.1093\/eurheartj\/ehy624"},{"key":"85705","doi-asserted-by":"crossref","unstructured":"Martinez-Garcia MA, S\u00e1nchez-de-la-Torre M, White DP, Azarbarzin A. Hypoxic burden in obstructive sleep apnea: present and future. Arch Bronconeumol 2023;59:36-43.","DOI":"10.1016\/j.arbres.2022.08.005"},{"key":"85706","doi-asserted-by":"crossref","unstructured":"Peker Y, Celik Y, Zinchuk A, et al. Association of hypoxic burden with cardiovascular events: a risk stratification analysis of the randomized intervention with CPAP in coronary artery disease and sleep apnea cohort. Chest 2025;168:1481-93.","DOI":"10.1016\/j.chest.2025.07.4081"},{"key":"85707","doi-asserted-by":"crossref","unstructured":"Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2017;13:479-504.","DOI":"10.5664\/jcsm.6506"},{"key":"85708","doi-asserted-by":"crossref","unstructured":"Soori R, Baikunje N, D'sa I, et al. Pitfalls of AHI system of severity grading in obstructive sleep apnoea. Sleep Sci 2022;15:285-8.","DOI":"10.5935\/1984-0063.20220001"},{"key":"85709","doi-asserted-by":"crossref","unstructured":"Malhotra A, Ayappa I, Ayas N, et al. Metrics of sleep apnea severity: beyond the apnea-hypopnea index. Sleep 2021;44:zsab030.","DOI":"10.1093\/sleep\/zsab030"},{"key":"85710","doi-asserted-by":"crossref","unstructured":"Redline S, Azarbarzin A, Peker Y. Obstructive sleep apnoea heterogeneity and cardiovascular disease. Nat Rev Cardiol 2023;20:560-73.","DOI":"10.1038\/s41569-023-00846-6"},{"key":"85711","doi-asserted-by":"crossref","unstructured":"Coso C, Solano-P\u00e9rez E, Romero-Peralta S, et al. The hypoxic burden, clinical implication of a new biomarker in the cardiovascular management of sleep apnea patients: a systematic review. Rev Cardiovasc Med 2024;25:172.","DOI":"10.31083\/j.rcm2505172"},{"key":"85712","doi-asserted-by":"crossref","unstructured":"Pau MC, Zinellu A, Mangoni AA, et al. Evaluation of inflammation and oxidative stress markers in patients with obstructive sleep apnea (OSA). J Clin Med 2023;12:3935.","DOI":"10.3390\/jcm12123935"},{"key":"85713","doi-asserted-by":"crossref","unstructured":"Hui X, Cao W, Xu Z, et al. Hypoxic indices for obstructive sleep apnoea severity and cardiovascular disease risk prediction: a comparison and application in a community population. Respirology 2024;29:825-34.","DOI":"10.1111\/resp.14754"}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4016\/2262","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4016\/2262","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:08:27Z","timestamp":1787735307000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/view\/4016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":17,"URL":"https:\/\/doi.org\/10.4081\/monaldi.2026.4016","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"value":"2532-5264","type":"electronic"},{"value":"1122-0643","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8,26]]}}}