[Health] Ventilatory Burden vs AHI

[Gideon]

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Huge Breakthrough in Sleep Apnea Scoring
BARRY KRAKOW, MD
SEP 18

As I’ve written about previously on Substack, in research publications, and in my books, scoring methods for understanding sleep apnea severity are crude tools at best, which is exactly the point made by researchers at the Mount Sinai Hospital group in NY. They invented a new automated technique to more precisely measure the burden of sleep apnea.
The current approach called AHI or RDI measures breathing in 30 second intervals, arbitrarily, and declares a breathing event depending on what happens in these 30 seconds.
The new technique is more precise as it analyzes each and every breath to define its unique status. They use a term “ventilatory burden;” in simpler language, they are searching for how much volume of air breathed during each breath. Smaller breaths are abnormal and serve as the principle point of analysis to determine severity.
The remarkable aspect of the work is the absence of measures for sleep or oxygen; and, through their analyses conducted on large databases of several thousand people, totaling 34 million unique breaths, they were able to link the ventilatory burden to cardiovascular risk.
Their overarching goal would provide doctors and patients with a much better measuring stick to assess sleep apnea severity and hopefully in the process convince insurance companies and the rest of the sleep medicine community to abandon the outdated AHI/RDI metric.
I hope you will share this post with friends and family who may be struggling with their sleep. It could be  life-saver.

[color=#404040][size=medium]Thank you for reading Fast Asleep. This post is public so feel free to share it.

Link to referenced study
https://www.mountsinai.org/about/newsroo...erm=678654

[Jay51]

Thank you for posting this Gideon.  I read through the article and found a few other statements about it on the internet:


"Automated ventilatory burden, which represents the proportion of overnight breaths with <50 percent normalized amplitude, can measure the severity of obstructive sleep apnea (OSA),"

"The Mount Sinai Sleep and Circadian Analysis Group developed an automated breath-by-breath measure called ventilatory burden that assesses the proportion of small breaths during a routine sleep study."

I am trying to understand this (it seems important to me).  It sounds like "tidal volume" is a huge stat to look at during sleep.  Not so much respiratory rate per say, but the total # of shallow breaths per night - they theorize that this causes the most damage to the body (cardiovascular, etc.).  It would seem to me that with OSA, use EPAP pressure (and possible soft cervical collar for positional apnea) to combat this.  With CSA, use a back up rate to ensure at least enough normal # of breaths.  (The standard treatments for both OSA and CSA).   So according to the measure, a person with a lower respiratory rate, but normal or higher than normal tidal volume would fair better than a person with a higher respiratory rate and lower tidal volume? 

[Gideon]

Volume varies by the "size" of a person, thus the new term of burden which should account for this. in determining "normal" volumes we take gender and height into consideration.

This is also the first time I've seen AI influencing the treatment of sleep apnea.

[CPAPfriend]

This is an exciting development. Overdue for an update in diagnostics. I think there were some earlier findings that sort of already said this, but worded it as flow limitation being highly associated with disease severity, but the automated algo with aspirations of refining it with machine learning to optimize its ability to screen for PAP-compliant patients is new and pretty cool. I've always wanted a clean answer as to why some patients respond to PAP and others do not, but none of the top healthcare professionals I've had the chance to have consultation with have provided a satisfying answer.

[Gideon]

I think this screams of a (very) long term shift to IVAPS where volume is maintained.

That said Fixed or CPAP mode will be needed for individuals intolerant of pressure changes.