Obstructive Sleep Apnea: A Cluster Analysis at Time of Diagnosis

Abstract

BackgroundThe classification of obstructive sleep apnea is on the basis of sleep study criteria that may not adequately capture disease heterogeneity. Improved phenotyping may improve prognosis prediction and help select therapeutic strategies. Objectives: This study used cluster analysis to investigate the clinical clusters of obstructive sleep apnea.MethodsAn ascending hierarchical cluster analysis was performed on baseline symptoms, physical examination, risk factor exposure and co-morbidities from 18,263 participants in the OSFP (French national registry of sleep apnea). The probability for criteria to be associated with a given cluster was assessed using odds ratios, determined by univariate logistic regression. Results: Six clusters were identified, in which patients varied considerably in age, sex, symptoms, obesity, co-morbidities and environmental risk factors. The main significant differences between clusters were minimally symptomatic versus sleepy obstructive sleep apnea patients, lean versus obese, and among obese patients different combinations of co-morbidities and environmental risk factors.ConclusionsOur cluster analysis identified six distinct clusters of obstructive sleep apnea. Our findings underscore the high degree of heterogeneity that exists within obstructive sleep apnea patients regarding clinical presentation, risk factors and consequences. This may help in both research and clinical practice for validating new prevention programs, in diagnosis and in decisions regarding therapeutic strategies.

Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

“…Variability in results can be expected, since the studies differed in the variables entered in the analyses. In addition, the studies are heterogeneous in the number of patients included, and only three studies were multicentric [89,90,93]. Finally, the complexity of OSA can affect the results.…”

“…These authors identified four main clinical phenotypes, corresponding to increasing severity of OSA, and six clusters, with no OSA and mild OSA as single clusters, moderate and severe OSA each subdivided into two clusters according to the presence or absence of significant comorbidities. Two studies, the largest to date, were published in 2016 on OSA patients from two French registries [90,93]. BAILLY et al [90] identified six clusters in the French OSA registry (>18 000 patients), corresponding to patients of different ages, with variable OSA severity and comorbidity burdens.…”

“…Two studies, the largest to date, were published in 2016 on OSA patients from two French registries [90,93]. BAILLY et al [90] identified six clusters in the French OSA registry (>18 000 patients), corresponding to patients of different ages, with variable OSA severity and comorbidity burdens. GAGNADOUX et al [93] identified five clusters in the multicentre prospective sleep cohort of the Institut de Recherche en Santé Respiratoire des Pays de la Loire (almost 6000 patients); interestingly, two clusters featured female OSA and OSA in minimally symptomatic elderly patients.…”

Obstructive sleep apnoea as a cause of nocturnal nondipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms

“…Furthermore, hypertension is increasingly recognised as an important predictor of prevalent OSA and appears to be more predictive than excessive day-time sleepiness in some settings [5]. However, recent evidence also indicates that only moderate-severe OSA (AHI >20 events·h -1 ) constitutes a significant independent risk for hypertension [2] and cluster analysis of sleep clinic populations indicates that particular population subtypes are especially associated with hypertension [6].These recent reports regarding the very high general prevalence of SDB and factors that influence the relationship with hypertension prompt a reassessment of the clinical relevance regarding the association between OSA and hypertension, especially nocturnal hypertension, and the underlying mechanisms that may contribute to the development of a nondipping nocturnal blood pressure profile in OSA patients. This topic is important in the context of the recent SAVE (Sleep Apnea Cardiovascular Endpoints) trial report [7] involving 2717 patients with established cardiovascular disease and moderate or severe OSA associated with minimal sleepiness who were randomised to best usual care with or without added continuous positive airway pressure (CPAP) therapy and followed for up to 7 years.…”

“…Furthermore, hypertension is increasingly recognised as an important predictor of prevalent OSA and appears to be more predictive than excessive day-time sleepiness in some settings [5]. However, recent evidence also indicates that only moderate-severe OSA (AHI >20 events·h -1 ) constitutes a significant independent risk for hypertension [2] and cluster analysis of sleep clinic populations indicates that particular population subtypes are especially associated with hypertension [6].…”