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Atul Malhotra, Indu Ayappa, Najib Ayas | SLEEP | (2021)
Primary Link Pubmed DOI Openalex Full text (OA)

Abstract

Obstructive sleep apnea (OSA) is thought to affect almost 1 billion people worldwide. OSA has well established cardiovascular and neurocognitive sequelae, although the optimal metric to assess its severity and/or potential response to therapy remains unclear. The apnea-hypopnea index (AHI) is well established; thus, we review its history and predictive value in various different clinical contexts. Although the AHI is often criticized for its limitations, it remains the best studied metric of OSA severity, albeit imperfect. We further review the potential value of alternative metrics including hypoxic burden, arousal intensity, odds ratio product, and cardiopulmonary coupling. We conclude with possible future directions to capture clinically meaningful OSA endophenotypes including the use of genetics, blood biomarkers, machine/deep learning and wearable technologies. Further research in OSA should be directed towards providing diagnostic and prognostic information to make the OSA diagnosis more accessible and to improving prognostic information regarding OSA consequences, in order to guide patient care and to help in the design of future clinical trials.

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William Fan
a year ago
William Fan's 2025 91 Day Weight Loss Challenge

Week 6: Obstructive Sleep Apnea

  • Weight (7d avg): 192.5.2lbs/87.3kg, from peak -7.2lbs/-3.3kg

  • RHR (7d avg): 56.9bpm

  • Calories In (7d avg): 1714kcal

  • Exercise (7d avg): 680kcal

  • Net Deficit (total): -4000kcal

  • 6x500m row sprints: 1:49.6

  • Deadlift: 402lbs (PR/PB)

Notes:

For the past few years, I've heard about the risks of Obstructive Sleep Apnea (OSA), a growing concern shared by a number of podcasters and health influencers. The prevalence of the disease as reported in the Lancet:

we estimated that 936 million (95% CI 903-970) adults aged 30-69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399-450) adults aged 30-69 years have moderate to severe obstructive sleep apnoea globally. The number of affected individuals was highest in China, followed by the USA, Brazil, and India.

This is a staggering percentage of people, a billion adults, or about 25% of the global adult population. The percentage goes up with age and for men. I thought it best to get it checked out.

After a night with a take home sleep test, my ENT went over my results. Apnea-Hypopnea Index (AHI) is the primary metric for diagnosing and classifying severity of sleep apnea. Effectively AHI measures the number of times you stop breathing or breath shallowly per hour, averaged over the course of your sleep time. While this metric has come under scrutiny as painting too simplistic a picture as discussed by the European Sleep Research Society and this article in the journal Sleep, it still remains the standard for diagnosis.

The AHI standard as stated is:

  • <5 events/hour = normal

  • 5–15 = mild

  • 15–30 = moderate

  • ≥30 = severe

My score ranged from 11 to 15, classifying me on the cusp of mild to moderate OSA. Even scarier, by blood oxygen saturation dropped to 82% in some instances during my sleep, putting me at higher risk for stroke. As I put on weight over the last few years, I began experiencing days with brain fog. I wondered if managing my OSA could prevent this and potentially help me lose weight. And so I signed up for a surgery that day for a week later.

As I went through the surgery and recovery process, I had so much more to learn and understand about OSA, which I'll touch on in future posts.

On a side note, I hit a personal record for deadlifts. A cool 402lbs, a number I was never sure I would hit. It was important for me to track my deadlift over this challenge as it provided a strength baseline. I did not want my weight loss to dramatically reduce my strength, so testing was a valuable way to see how my calorie deficit and weight loss were impacting my lifts.

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