Skip to main content

Main menu

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Peer reviewer login
  • Journal club
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Peer reviewer login
  • Journal club
  • Alerts
  • Subscriptions

Defining obstructive sleep apnoea syndrome: a failure of semantic rules

Renata L. Riha
Breathe 2021 17: 210082; DOI: 10.1183/20734735.0082-2021
Renata L. Riha
1Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK.
2Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Renata L. Riha
  • For correspondence: rlriha@hotmail.com
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1

    Distribution of ESS in randomly selected individuals from the community and patients on CPAP. Reproduced from [24] with permission.

  • Figure 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2

    Differences in the prevalence of OSA in a cohort of patients in Lausanne, Switzerland, based on criterion C of the ICSD-3 (2014) definition according to different scoring criteria for hypopnoeas as mandated by the AASM scoring guidelines in 1999, 2007 and 2012. a) Whole cohort, b) males and c) females. Reproduced from [36] with permission.

  • Figure 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 3

    Schema of risk factors and mechanisms in the pathogenesis of OSA/OSAS and how they can be addressed in precision treatment. MAD: mandibular advancement device; HGNS: hypoglossal nerve stimulation. Reproduced from [54] with permission.

Tables

  • Figures
  • Table 1

    Definitions of OSA/OSAS according to the International Classification of Sleep Disorders (ICSD) to date (May, 2021)

    ICSD-1 (1990)
    ICSD-R (1997) [6]
    Terminology: obstructive sleep apnoea syndrome
    Diagnostic criteria: minimal criteria A plus B plus C
    No differentiation between adults and children.
    No alternate names.
    Duration criteria:

    Acute: 2 weeks or less.
    Subacute: >2 weeks but <6 months.
    Chronic: ≥6 months.
    • A. The patient has a complaint of excessive sleepiness or insomnia. Occasionally, the patient may be unaware of clinical features that are observed by others.

    • B. Frequent episodes of obstructed breathing occur during sleep.

    • C. Associated features include:

      • 1. Loud snoring.

      • 2. Morning headaches.

      • 3. A dry mouth upon awakening.

      • 4. Chest retraction during sleep in young children.

    • D. Polysomnographic monitoring demonstrates:

      • 1. More than 5 obstructive apnoeas, >10 s in duration, per hour of sleep and one or more of the following:

        • a. Frequent arousals from sleep associated with apnoeas.

        • b. Bradytachycardia.

        • c. Arterial oxygen desaturation in association with apnoeic episodes.

      • 2. MSLT may or may not demonstrate a mean sleep latency of <10 min.

    • E. The symptoms can be associated with other medical disorders (e.g. tonsillar enlargement).

    • F. Other sleep disorders can be present (e.g. periodic limb movement disorder or narcolepsy).

    Severity criteria
    Mild: Associated with mild sleepiness or mild insomnia. Most of the habitual sleep period is free of respiratory disturbance. The apnoeic episodes are associated with mild oxygen desaturation or benign cardiac arrhythmias.
    Moderate: Associated with moderate sleepiness or mild insomnia, as defined. The apnoeic episodes can be associated with moderate oxygen desaturation or mild cardiac arrhythmias.
    Severe: Associated with severe sleepiness, as defined. Most of the habitual sleep period is associated with respiratory disturbance, with severe oxygen desaturation or moderate-to-severe cardiac arrhythmias. There can be evidence of associated cardiac or pulmonary failure.
    ICSD-2 (2005) [7]
    Separate definitions for adults and children.
    Alternate names: obstructive sleep apnoea syndrome, sleep apnoea, sleep apnoea syndrome, obstructive apnoea, mixed sleep apnoea, sleep disordered breathing, sleep hypopnoea syndrome, upper airway obstruction.
    Upper airway resistance syndrome subsumed under the diagnosis.
    No duration criteria.
    No associated cardiac or other pathophysiology is mentioned.
    Terminology: obstructive sleep apnoea, adult
    A, B and D, or C and D satisfy the criteria
    A. At least one of the following applies:
    1. The patient complains of unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue or insomnia.
    2. The patient wakes with breath holding, gasping, or choking.
    3. The bed partner reports loud snoring, breathing interruptions, or both during the patient's sleep.
    B. Polysomnographic recording shows the following:
    1.5 or more scoreable respiratory events (i.e. apnoeas, hypopnoeas, or RERAs) per hour of sleep.
    2. Evidence of respiratory effort during all or a portion of each respiratory event (in the case of a RERA, this is best seen with the use of oesophageal manometry).
    or
    C. Polysomnographic recording shows the following:
    1.15 or more scoreable respiratory events (i.e. apnoeas, hypopnoeas, or RERAs) per hour of sleep.
    2. Evidence of respiratory effort during all or a portion of each respiratory event (in the case of a RERA, this is best seen with the use of oesophageal manometry).
    D. The disorder is not better explained by another current sleep disorder, medical or neurological disorder, medication use, or substance use disorder.
    ICSD-3 (2014) [8]
    Separate definitions for adults and children.
    Alternate names: OSA syndrome, sleep apnoea, sleep apnoea syndrome, obstructive apnoea, sleep disordered breathing, obstructive sleep apnoea hypopnoea syndrome.
    Upper airway resistance syndrome subsumed under the diagnosis.
    No duration criteria.
    Terminology: obstructive sleep apnoea, adult
    A and B, or C satisfy the criteria
    A. The presence of one or more of the following:
    1. The patient complains of sleepiness, nonrestorative sleep, fatigue, or insomnia symptoms.
    2. The patient wakes with breath holding, gasping, or choking.
    3. The bed partner or other observer reports habitual snoring, breathing interruptions, or both during the patient's sleep.
    4. The patient has been diagnosed with hypertension, a mood disorder, cognitive dysfunction, coronary artery disease, stroke, congestive heart failure, atrial fibrillation, or type 2 diabetes mellitus.
    B. PSG or OCST# demonstrates: 5 or more predominantly obstructive respiratory events¶ (obstructive and mixed apnoeas, hypopnoeas, or RERAs+ per hour of sleep during a PSG or per hour of monitoring (OCST#).
    or
    C. PSG or OCST# demonstrates: 15 or more predominantly obstructive respiratory events (apnoeas, hypopnoeas, or RERAs+) per hour of sleep during a PSG or per hour of monitoring (OCST#).

    MSLT: multiple sleep latency test; RERA: respiratory effort related arousal; PSG: polysomnography; OCST: out of centre sleep testing (no electroencephalogram (EEG) is recorded). #: OCST commonly underestimates the number of obstructive respiratory events per hour as compared to PSG because actual sleep time, as determined primarily by EED, is often not recorded. The term respiratory event index (REI) may be used to denote event frequency based on monitoring time rather than total sleep time. ¶: Respiratory events defined according to the most recent version of the American Academy of Sleep Medicine manual for the scoring of sleep and associated events. +: RERAs and hypopnoea events based on arousals from sleep cannot be scored using OCST because arousals by EEG criteria cannot be identified. Information from [6–8].

    PreviousNext
    Back to top
    Vol 17 Issue 3 Table of Contents
    Breathe: 17 (3)
    • Table of Contents
    • Index by author
    Email

    Thank you for your interest in spreading the word on European Respiratory Society .

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Defining obstructive sleep apnoea syndrome: a failure of semantic rules
    (Your Name) has sent you a message from European Respiratory Society
    (Your Name) thought you would like to see the European Respiratory Society web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Print
    Citation Tools
    Defining obstructive sleep apnoea syndrome: a failure of semantic rules
    Renata L. Riha
    Breathe Sep 2021, 17 (3) 210082; DOI: 10.1183/20734735.0082-2021

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero

    Share
    Defining obstructive sleep apnoea syndrome: a failure of semantic rules
    Renata L. Riha
    Breathe Sep 2021, 17 (3) 210082; DOI: 10.1183/20734735.0082-2021
    del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
    Full Text (PDF)

    Jump To

    • Article
      • Abstract
      • Abstract
      • Introduction
      • How do we define OSAS?
      • Defining sleepiness
      • Defining OSA
      • Defining OSAS severity
      • Pathophysiology, endotypes and phenotypes of OSAS: importance to the definition
      • Conclusion
      • Footnotes
      • References
    • Figures & Data
    • Info & Metrics
    • PDF

    Subjects

    • Sleep medicine
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    More in this TOC Section

    • Holistic management of patients with progressive pulmonary fibrosis
    • Mimics of pathology on paediatric chest imaging studies
    • Routine FEV1 measurement in diagnosis and monitoring of childhood asthma
    Show more Reviews

    Related Articles

    Navigate

    • Home
    • Current issue
    • Archive

    About Breathe

    • Journal information
    • Editorial board
    • Press
    • Permissions and reprints
    • Advertising

    The European Respiratory Society

    • Society home
    • myERS
    • Privacy policy
    • Accessibility

    ERS publications

    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS books online
    • ERS Bookshop

    Help

    • Feedback

    For authors

    • Intructions for authors
    • Publication ethics and malpractice
    • Submit a manuscript

    For readers

    • Alerts
    • Subjects
    • RSS

    Subscriptions

    • Accessing the ERS publications

    Contact us

    European Respiratory Society
    442 Glossop Road
    Sheffield S10 2PX
    United Kingdom
    Tel: +44 114 2672860
    Email: journals@ersnet.org

    ISSN

    Print ISSN: 1810-6838
    Online ISSN: 2073-4735

    Copyright © 2023 by the European Respiratory Society