Beyond the apnea-hypopnea index: symptomatic assessment as a treatment pathway for obstructive sleep apnea management

Obstructive sleep apnea (OSA) is a highly prevalent condition, with positive airway pressure (PAP) being the most studied and widely used treatment modality. While a variety of non-PAP therapies have been explored over the years, none have demonstrated the same efficacy in addressing the apnea-hypopnea index (AHI) as PAP therapy. PAP is capable of almost completely eliminating breathing events, regardless of the patient’s age, body mass index, endotypes, or comorbidities. However, there is a critical issue to address: AHI has not been consistently correlated with symptomatic outcomes, such as daytime sleepiness and overall sleep quality. By analyzing clinical subtypes and their symptomatic profiles, various studies have proposed that a broader approach could improve diagnostic accuracy and better predict cardiovascular outcomes [1, 2]

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Almeida, moving beyond AHI and considering symptoms.pdf

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