0508 Age-Related Disparities in Sleep Apnea Diagnosis: Implications of 4% vs. 3% Hypopnea Scoring Criteria

Abstract Introduction The distinction between mild, moderate, and severe apnea is crucial, as it classifies patients into different categories of modifiable risk factors. In hypopnea scoring, Centers for Medicare and Medicaid Services use the 4% criterion, differing from American Academy of Sleep Medicine 's 3%, affecting AHI measurement and the assessment of apnea severity. This study examines age-related differences in the application of these two criteria leading to different apnea severity diagnosis and to potential under-treatment, especially in the elderly. Methods An FDA-cleared home sleep test (SleepImage Ring 2.3.0) was utilized with clinical diagnosis involving a comprehensive review by a Board-Certified Sleep Medicine Physician. Descriptive statistics and the chi-square test were employed to assess differences in frequencies. The Bland-Altman method was used to evaluate the difference in AHI estimation between the two scoring criteria, calculating the mean difference (bias) and 95% limits of agreement. Results In total, 1,021 subjects (mean age 53.3±14.7 years) were analyzed. The Bland-Altman plot revealed the average bias was 8.76 (95% CI: 8.46-9.06), with the 3% criterion yielding higher values. In subjects aged 18-30 years, the most significant discordance was for the diagnosis of mild OSA (35.8%), diagnosed as normal by the 4% criterion. Interestingly, this criterion classified 2.5% of subjects as normal who were moderate by the 3% criterion. Similarly, in subjects aged 41-50 years, the greatest discordance was for mild OSA (29.8%), and 24.9% were classified as having moderate OSA by the 3% criterion but mild by the 4% criterion. For subjects aged 51-60 years, the greatest discordance was in subjects classified as having moderate OSA by the 3% criterion but mild by the 4% criterion (29.4%), and the agreement on normality was very low (6.3%). The last two age groups (61-70 and 70 years) showed a pattern of concordance/discordance very similar to that of subjects aged 51-60 years. Conclusion Our study unveils notable disparities in hypopnea scoring criteria (4% vs. 3%). Over 20% of individuals aged 70 and above with OSA may be under-treated using the 4% criterion, emphasizing the necessity for nuanced OSA diagnosis in older individuals to ensure precise care. Support (if any)