Evaluation of a multicomponent grading system for obstructive sleep apnoea: the Baveno classification

Abstract

New findings on pathophysiology, epidemiology, and outcome have raised concerns on the relevance of the apnoea-hypopnoea index (AHI) in the classification of obstructive sleep apnoea (OSA) severity. Recently, a multicomponent grading system, decision integrating symptomatology and comorbidities (Baveno classification), was proposed to characterise OSA and to guide therapeutic decisions. We evaluated if this system reflects the OSA population, if it translates into differences in outcomes, and if the addition of AHI improves the scheme. 14 499 OSA patients from the European Sleep Apnoea Database (ESADA) cohort were analysed. The groups were homogeneously distributed and were found to clearly stratify the population with respect to baseline parameters. Differences in sleepiness and blood pressure between the groups were analysed in a subgroup of patients after 24–36 months of treatment. Group A (minor symptoms and comorbidities) did not demonstrate any effect of treatment on outcome. However, groups B (severe symptoms, minor comorbidities), C (minor symptoms, severe comorbidities) and D (severe symptoms and comorbidities) were associated with improvement in either or both parameters with treatment. The AHI is an essential prerequisite of the diagnosis. However, adding the AHI did not improve the classification. Rather, it was inferior with respect to guiding the treatment decision. Thus, the Baveno classification allows a better stratification of the OSA population and may provide a better guidance for therapeutic decisions in OSA.

Arterial Stiffness Assessment Using the Arteriograph in Patients with Moderate–Severe OSA and Metabolic Syndrome—A Pilot Study

“…However, contrary to the results of Joyeux-Faure et al [ 48 ], in our analysis aoPWV was strongly correlated with mean nocturnal O 2 Sa, which was also associated with weight, BMI, and WC. Our results are in line with the ”hypoxemic burden” theory in OSA patients, in which an integrated symptom–comorbidity approach aims to replace AHI as the central parameter in the OSA treatment algorithm [ 41 ].…”

“…CPAP adherence in our study (51.28%) was significantly lower than that in previous reports [ 18 , 39 ], but similar to that observed by Dorkova et al [ 40 ] in patients with severe OSA and MS. The poor CPAP adherence could be explained by the relatively low average ESS score observed in our study group [ 41 ], as well as by the presence of MS per se [ 42 ].…”

“…Although similar limitations could be attributed to the Arteriograph (TensioMed, Budapest, Hungary) device, aoPWV and aoSBP improvement occurred in the absence of statistically significant BP or HR variations (the most important confounding factors for PWV [ 29 ]), and remained significant after BMI adjustment. The mild decrease in aoPWV can be explained by the rather low baseline aoPWV (“pathological” values of >10 m/s [ 4 ] in only 35% of patients; Figure 1 ), by the short follow-up duration (8 weeks) and by the low initial ESS score [ 41 ]. CPAP seems to be more effective in improving BP in symptomatic OSA patients (excessive sleepiness) with associated cardiovascular comorbidities, including MS.…”

Defining obstructive sleep apnoea syndrome: a failure of semantic rules

“…Most recently, a study using the “Baveno” classification, a multicomponent grading system for OSA [ 60 ], was tested in the ESADA cohort in 14 499 patients with a diagnosis of OSAS who were on treatment [ 61 ]. Groups were classified into patients with minor symptoms and cardiometabolic comorbidities (Group A), severe symptoms and minor cardiometabolic comorbidities (Group B), minor symptoms and severe cardiometabolic comorbidities (Group C) and severe symptoms and cardiometabolic comorbidities (Group D).…”

“…Approximately 70% of the patients in the entire group were on CPAP and a subgroup were followed up for 24–36 months. The major findings (apart from reasonable ease of classification) showed that Groups B, C and D improved on treatment with CPAP on several cardiometabolic parameters and that the AHI did not improve the classification integrity [ 61 ].…”