Criteria
International Classification of Sleep Disorders (ICSD-3-TR) OSA diagnostic criteria[1]
For a diagnosis of OSA, criteria A, B and D, or C and D, must be met:
The presence of at least one of the following:
Patient reports sleepiness, fatigue, insomnia, or symptoms impairing sleep-related quality of life
Patient reports awakening short of breath, gasping, or choking
Bed partner or observer reports habitual snoring or witness apnoea
For (B) or (C), polysomnography (PSG), per hour of sleep or home sleep apnoea test (HSAT), per hour of monitoring demonstrates:
≥5 predominantly obstructive respiratory events (obstructive and mixed apnoeas, hypopnoeas, or respiratory effort-related arousals)
≥15 predominantly obstructive respiratory events
The disorder is not better explained by another current sleep disorder, a medical disorder, medication or a substance use
Apnoea-Hypopnoea Index (AHI)[12]
The AHI is calculated as the number of respiratory events (apnoeas, hypopnoeas) divided by the number of hours of sleep recorded during a PSG study, where apnoea severity is defined as:
mild: ≥5 to <15 events/hour
moderate: ≥15 to <30 events/hour
severe: ≥30 events/hour
Respiratory Event Index (REI)[12]
The REI is calculated as the number of respiratory events divided by the number of hours of estimated sleep using a home sleep apnoea test, where apnoea severity is defined as:
mild: ≥5 to <15 events/hour
moderate: ≥15 to <30 events/hour
severe: ≥30 events/hour
OSA may be diagnosed if the AHI and REI is ≥15 episodes/hour and if there seems to be no other underlying sleep, medical, or neurological disorder, or symptoms are not attributable to medicine or drug use.[1]
Symptoms and AHI or Respiratory Disturbance Index (RDI) (Medicare criteria)[67]
In the US, per Medicare criteria, OSA may be diagnosed by AHI or RDI (respiratory distress events during sleep; includes respiratory-effort-related arousals) of ≥15 episodes/hour, with a minimum of 30 events in the study; or by an AHI or RDI of ≥5 episodes/hour, with a minimum of 10 events in the study with one of the following comorbidities: hypertension, ischaemic cardiac disease, history of stroke, excessive daytime sleepiness, insomnia, mood disorder, or cognitive dysfunction.[67] The RDI term applies to a home study.[67]
Epworth Sleepiness Scale (ESS)[90]
ESS assesses expectation of dozing in various situations (including sitting and reading, watching TV, sitting inactive in a public place, and sitting and talking to someone):[90] Epworth Sleepiness Scale Opens in new window
Score of 9 to 10 is considered threshold for sleepiness (0 to 8 normal, 9 to 12 mild, 13 to 16 moderate, more than 16 severe).
Score of more than 10 is reported to have 93.5% sensitivity and 100% specificity at distinguishing pathological from normal daytime sleepiness.
Not adjusted for age, sleep deprivation, or medicine use.
Biological sex, psychological variables, subjective perception of fatigue, and lack of energy can all affect patient rating.
ESS score does not correlate well with objective sleepiness testing and is affected by the presence of alerting factors.
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