Abstract
Snoring affects not only the bed-partner’s sleep quality, but may also cause the break down in the marriage and relationship. Sleepiness, poor concentration and irritability affects quality of life, work and productivity. Successful treatment of an OSA patient would imply reversing debilitating symptoms faced by the patient, including the metabolic and oxidative stress that accompanies the disease load/burden. There is widespread evidence showing significant discordance between AHI used to denote outcomes of therapy and real-world clinical outcomes such as QOL, patient perception of disease, cardiovascular measures, disease burden and/or survival. It is widely accepted that AHI can vary from night to night, from laboratory to laboratory, from various nasal thermistor to pressure transducers. Different definitions of hypopnea used in different laboratories and software affect AHI values. The reliance on AHI as the only outcome measure assessed in clinical research is not in line with many other aspects of medicine that are becoming patient-centered as opposed to test-centered. Outcome measures of OSA should be based on end-organs effects rather than only one highly variable parameter, AHI. Too much weightage has been given to this single parameter (AHI) that is well known for its variability. Patients are concerned and affected by “real tangible” issues like loud snoring, daytime sleepiness, uncontrolled hypertension, obesity, high glucose levels; these are the effects of OSA as a systemic disease affecting end-organs, manifesting as these patient related symptoms or complaints. An example of more comprehensive outcome parameters would include end-organ effects like the Blood Pressure, Gross Weight (BMI), Oxygen Time Spent below 90% (T90), and AHI; these were collectively introduced as the Sleep Goal Index. This review article will highlight the short-comings of the AHI and illustrate holistic outcome measures that better reflect the oxidative stress that affect the OSA patient.