Although commonly observed in clinical practice, the heterogeneity of obstructive sleep apnoea (OSA) clinical presentation has not been formally characterised.This study was the first to apply cluster analysis to identify subtypes of patients with OSA who experience distinct combinations of symptoms and comorbidities. An analysis of baseline data from the Icelandic Sleep Apnoea Cohort (822 patients with newly diagnosed moderate-to-severe OSA) was performed.Three distinct clusters were identified. They were classified as the ''disturbed sleep group'' (cluster 1), ''minimally symptomatic group'' (cluster 2) and ''excessive daytime sleepiness group'' (cluster 3), consisting of 32.7%, 24.7% and 42.6% of the entire cohort, respectively. The probabilities of having comorbid hypertension and cardiovascular disease were highest in cluster 2 but lowest in cluster 3. The clusters did not differ significantly in terms of sex, body mass index or apnoea-hypopnoea index.Patients with OSA have different patterns of clinical presentation, which need to be communicated to both the lay public and the professional community with the goal of facilitating care-seeking and early identification of OSA. Identifying distinct clinical profiles of OSA creates a foundation for offering more personalised therapies in the future. @ERSpublications This study identified 3 different subtypes of patients with obstructive sleep apnoea based on clinical presentations http://ow.ly/AjuEZ

No abstract

OSA treatment response patterns differed by initial clinical phenotype and PAP adherence. Individuals with insomnia-related symptoms may require additional targeted therapy for these complaints. These findings underscore the need for a personalized approach to management that recognizes patients with a range of OSA presentations.

Summary This study aimed to identify pre-treatment and immediate early treatment factors predicting continuous positive airway pressure (CPAP) use during the first week of therapy, when the pattern of non-adherence is established. Four domains of potential predictors were examined: pre-treatment demographic and clinical factors, patients’ perceived self-efficacy, treatment delivery (mask leak and bothering side effects), and immediate disease reduction (residual respiratory events and flow limitation). The Autoset™ Clinical System objectively documented daily CPAP use, mask leak, residual respiratory events, and flow limitation. Ninety-one CPAP-naïve patients with newly diagnosed obstructive sleep apnea were followed for 1 week after treatment initiation. Mean CPAP daily use during the first week was 3.4 ± 2.7 hours, with significantly lower use observed in Black than non-Black participants (2.7 vs. 4.4 hours, respectively, p= 0.002). Less intimacy with partners caused by CPAP was the only treatment side effect correlated with CPAP use (r= -0.300, p=0.025). Reduced CPAP use during the first week was simultaneously associated with being Black, higher residual apnea-hypopnea index, and the treatment side effect of less intimacy with partners. The three factors together accounted for 25.4% of the variance in the CPAP use (R2=0.254, p<0.01). These data suggest the need to assess the impact of CPAP on intimacy and troubleshoot aspects of the treatment that interfere with sexual relationships. Assessing the presence of residual respiratory events may be important in promoting CPAP adherence. The association of race and CPAP use needs to be further explored by including more socioeconomic information.

Scientific inveStigAtionSobjectives: Whether gender differences exist in clinical manifestations of obstructive sleep apnea (OSA) and whether women's responses to continuous positive airway pressure (CPAP) are similar to those of men are critical areas of exploration in sleep disordered breathing. This exploratory analysis addressed these questions by examining gender differences over a wide range of clinical outcomes at baseline and in response to CPAP in participants with severe OSA. Methods: Data from 152 men and 24 women who participated in a multicenter CPAP effectiveness study were analy�ed. Gender differ-CPAP effectiveness study were analy�ed. Gender differ-effectiveness study were analy�ed. Gender differences in functional status (functional outcomes of sleep questionnaire, sickness impact profile), daytime sleepiness (epworth sleepiness scale, multiple sleep latency test), mood disturbance (profile of mood states), apnea symptoms (multivariable apnea prediction index), and neurobehavioral performance (psychomotor vigilance task) were examined. Treatment response was examined by the change in each outcome from baseline to 3 months after treatment. Results: Despite similar age, body mass index, and apnea-hypopnea index, women reported significantly lower functional status, more subjective daytime sleepiness, higher frequency of apnea symptoms, more mood disturbance, and poorer neurobehavioral performance compared to men at baseline. CPAP treatment significantly improved functional status and relieved symptoms for both genders. The magni-The magni-he magnitude of improvement in each clinical outcome did not vary by gender. conclusions: Women with OSA showed greater impairment in daytime functioning and symptoms than men. Both genders benefit from CPAP treatment. Adequately powered studies considering possible re-treatment. Adequately powered studies considering possible re-treatment. Adequately powered studies considering possible referral and response bias are necessary to examine gender differences in OSA clinical manifestations and response to CPAP treatment.