Beyond Apnea-Hypopnea Index: How Clinical and Comorbidity Are Important in Obstructive Sleep Apnea

Abstract

Introduction: The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comor-bidities. The aim of our study was to evaluate the application of the Baveno classification in clinical practice and to explore its association with sleep indices, adherence to therapy and symptoms over a 6-months period. Material and methods: Prospective study including patients diagnosed with OSA between January and July 2021 was conducted. Patients were divided into 4 groups (A–D) according to the Baveno classification. The adherence to PAP treatment and Epworth Sleepiness Scale (ESS) values were obtained 6 months after initiation of therapy. Results: A total of 91 patients (84% male, 58 ± 13 years) were included in the study. The median ESS score was 10 (6–15), mean AHI was 28.4 ± 22.2 events/hour and the time with SpO2 < 90% (T90) was 9.7 ± 14.9%. At diagnosis, patients were classified into Baveno groups: A: 30%; B: 35%; C: 17%, D: 19%. There were no statisti-cal differences in AHI between the different groups. On the other hand, T90 had higher values in patients with comorbidities (C, D). Regarding the treatment, the prescription of PAP was higher in patients with comorbidities (C, D), and adherence to this treatment at 6 months was higher in group D. Among patients under PAP therapy, there was a statistically significant decrease in daytime sleepiness at 6 months in groups B and D. Conclusions: The Baveno classification distributes pa-tients with OSA evenly across the different phenotypes, regardless of the AHI value. The treatment decision was linked to the comorbidities (C, D) were the ones who had the greatest adherence to treatment at 6 months were in group D. ESS improved with greater emphasis in the most sympto-matic (B, D), while the AHI is essential for the diagnosis of OSA, the Baveno classification may guide physicians better in their treatment decision.

Implementation of the Baveno Classification in Obstructive Sleep Apnea and Its Correlation with Symptoms of Anxiety and Depression

“…Although the authors of this study did not prove a relationship between the AHI index and comorbidities, a relatively higher AHI value was found in group D [17].…”

Unraveling sleep respiratory dysfunction in amyotrophic lateral sclerosis: Beyond the apnea-hypopnea index and sleep-related hypoxia

“…Common metrics for polygraphic sleep scoring can be misleading in faithfully representing diseases’ severity. In recent years, growing attention has been dedicated to the identification of factors determining the severity of OSA, moving beyond the (highly simplistic) AHI paradigm [ 18 ]. Indeed, AHI demonstrated to fail when it comes to a representative phenotypization of OSA patients [ 19 ].…”

Severity of OSA—A multitude of Predictors

“…Compliance was found by Sousa et al [1] to be maximum in patients having symptoms and comorbidities. However, it has also been seen that anatomical factor including large tonsils and turbinate hypertrophy lead to decreased compliance with Positive airway pressure (PAP) therapy [4].…”

“…We read with interest the recent article published by Sousa et al [1] regarding the utility of phenotyping patients of OSA. The use of Baveno classification to grade Obstructive Sleep Apnea (OSA) patients in A, B, C and D groups based on symptoms and comorbidities has been suggested to guide treatment better than Apnea Hypopnea Index (AHI).…”