Beyond the apnea-hypopnea index: a call to action for a multidimensional evaluation in obstructive sleep apnea

Obstructive sleep apnea (OSA) is a highly heterogeneous chronic disease, in which the conventional measure of disease severity, the apnea-hypopnea index (AHI), correlates poorly with patient-reported symptoms and inconsistently with cardiovascular outcomes. The present perspective proposes an initial discussion of a new concept for multidimensional evaluation of patients with OSA that integrates both objective measures of upper airway obstruction (AHI) and chronic intermittent hypoxia (hypoxic burden), along with subjective assessments of nighttime and daytime symptoms burden including snoring, subjective sleep quality, daytime sleepiness, fatigue, and quality of life. This integrated approach aims to improve characterization of patients and guide more individualized therapeutic goals, including improvements in quality of life and reduction in cardiovascular and metabolic consequences. It also supports a call to action in the OSA field, encouraging the development of a more comprehensive assessment of treatment response and clinical meaningfulness in OSA.