why 5?

wolewyck · Post by **wolewyck** » Sat Jan 08, 2011 10:33 pm

Does anyone know why (i.e., on what basis) an AHI of 5 is considered the threshold for normal vs apnea? I'd love to see some cites, if y'all happen to know...

Goofproof · Post by **Goofproof** » Sat Jan 08, 2011 11:33 pm

Because someone felt a number was needed for a standard of treatment. My standard is as low as possible, under 2 is my goal, and yes, I can feel the difference. Jim

idamtnboy · Post by **idamtnboy** » Sat Jan 08, 2011 11:43 pm

wolewyck wrote:Does anyone know why (i.e., on what basis) an AHI of 5 is considered the threshold for normal vs apnea? I'd love to see some cites, if y'all happen to know...

As you sometimes tell your little child, "Just because!"

Seriously, this topic was discussed several weeks ago here: viewtopic.php?f=1&t=57377&p=539750&hili ... ne#p539750. You'll probably get about as good an answer looking at that thread as there is.

idamtnboy · Post by **idamtnboy** » Sat Jan 08, 2011 11:52 pm

wolewyck wrote:Does anyone know why (i.e., on what basis) an AHI of 5 is considered the threshold for normal vs apnea? I'd love to see some cites, if y'all happen to know...

Here's another thread where this was discussed.
viewtopic.php?f=1&t=57015&st=0&sk=t&sd=a

rested gal · Post by **rested gal** » Sun Jan 09, 2011 4:00 am

In that last thread idamtnboy linked to:

viewtopic.php?p=511023#p511023

On page 3 of that topic:

-SWS wrote:This excerpt from Promise of Sleep describes how Stanford sleep medicine pioneers William Dement and Christian Guilleminault devised an AHI-of-5 as the original apnea/hypopnea clinical cut off in 1973:
William C Dement in [i]PROMISE OF SLEEP[/i] wrote:In 1973 Christian Guilleminault and I proposed the measure that is still used for the clinical definition of sleep apnea and for rating its severity. We called it the Apnea/Hypopnea Index (AHI). Hypopnea is the term we use when the throat doesn't quite close entirely, but air flow is reduced sufficiently to lower oxygen and cause an arousal. The AHI score represents the average number of Apnea and Hypopnea episodes that a patient has during an hour of sleep. We decided that an AHI of 5 should be the lower limit for making a diagnosis of apnea, so a score of less than 5 (breathing stops fewer than 5 times per hour) is considered too low for clinical diagnosis and doesn't require treatment. However treatment may be necessary if a patient has an AHI of 5 to 10 with other signs or symptoms of apnea such as daytime fatigue or high blood pressure. Although not all my colleagues agree, I feel strongly that people with an AHI of 10 to 20 should definitely consider treatment, even if they are not feeling sleepy during the day. In my opinion, anyone with a score over 20 should always be treated - they will soon have a serious, life-threatening problem."
Sleep medicine and Medicare still adhere to Dement's and Guilleminault's AHI-of-5 as clinical cut-off criterion to this day.

Below is a recap of one classic debate between doctors Sullivan and Rapoport, two sleep medicine legends in their own right. They argue AHI's usefulness as an apnea/hypopnea severity marker in the year 2002:

http://www.pulmonaryreviews.com/sep02/p ... Index.html

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