Polysomnographic phenotyping of obstructive sleep apnea and its implications in mortality in Korea

Kim, Jeong Whun; Won, Tae Bin; Rhee, Chae Seo; Park, Young Mi; Yoon, Il; Cho, Sung Woo

doi:10.1038/s41598-020-70039-5

Cited by 24 publications

(15 citation statements)

References 48 publications

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“…A similar phenotype to OSA and PLM was found in a Korean study where, similarly to our study, it was the least common and with the highest PLMS count, oldest patient group and lowest Epworth sleepiness scale scores. The main difference to our study, was that these patients had the lowest quality of sleep, which contributes to higher arousal and awakening rates mentioned above [24]. In another recently published study, a phenotype related to periodic limb movements was connected to a two-fold higher cardiovascular or cerebrovascular event risk [25].…”

Section: Discussioncontrasting

confidence: 64%

“…A close to Severe OSA phenotype, which displayed AHI average of almost 70 times/hour, was described in the earlier mentioned Korean study, and was associated with a higher cardiovascular and cerebrovascular event risk [24]. Another study compared different phenotypes between men and women and discovered, that both sexes had phenotypes with severe OSA features [26].…”

Section: Discussionmentioning

confidence: 68%

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Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness

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Background and Objective: Obstructive sleep apnea (OSA) is a heterogeneous chronic sleep associated disorder. A common apnea-hypopnea index (AHI)-focused approach to OSA severity evaluation is not sufficient enough to capture the extent of OSA related risks, it limits our understanding of disease pathogenesis and may contribute to a modest response to conventional treatment. In order to resolve the heterogeneity issue, OSA patients can be divided into more homogenous therapeutically and prognostically significant groups–phenotypes. An improved understanding of OSA phenotype relationship to treatment effectiveness is required. Thus, in this study several clinical OSA phenotypes are identified and compared by their treatment effectiveness. Methods and materials: Retrospective data analysis of 233 adult patients with OSA treated with continuous positive airway pressure (CPAP) was performed. Statistical analysis of data relating to demographic and anthropometric characteristics, symptoms, arterial blood gas test results, polysomnografic and respiratory polygraphic tests and treatment, treatment results was performed. Results: 3 phenotypes have been identified: “Position dependent (supine) OSA” (Positional OSA), “Severe OSA in obese patients” (Severe OSA) and “OSA and periodic limb movements (PLM)” (OSA and PLM). The highest count of responders to treatment with CPAP was in the OSA and PLM phenotype, followed by the Positional OSA phenotype. Treatment with CPAP, despite the highest mean pressure administered was the least effective among Severe OSA phenotype. Conclusions: Different OSA phenotypes vary significantly and lead to differences in response to treatment. Thus, treatment effectiveness depends on OSA phenotypes and treatment techniques other than CPAP may be needed. This emphasizes the importance of a more individualized approach when treating OSA.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 68%

Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness

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“…Lastly, the diagnostic method of sleep apnea may not be unified. However, the diagnosis of sleep apnea was usually done using polysomnography according to recently published data in Korea 40 , 41 . Since the aim of this study was not about the exact diagnosis of OSA, but to examine the relationship between clinically significant OSA and NAFLD, we used the ICD-code to define OSA as previous study 42 .…”

Section: Discussionmentioning

confidence: 99%

Nonalcoholic fatty liver disease is associated with the development of obstructive sleep apnea

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Yoo

et al. 2021

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Increasing evidence suggests that obstructive sleep apnea (OSA) is a metabolic syndrome-related disease; however, the association between nonalcoholic fatty liver disease (NAFLD) and OSA is not firmly established. In this study, we investigated the relationship between NAFLD and OSA in a general population drawn from a nationwide population-based cohort. Data from the Korean National Health Insurance System between January 2009 and December 2009 were analyzed using Cox proportional hazards model. NAFLD was defined as a fatty liver index (FLI) ≥ 60 in patients without excessive alcohol consumption (who were excluded from the study). Newly diagnosed OSA during follow-up was identified using claims data. Among the 8,116,524 participants, 22.6% had an FLI score of 30–60 and 11.5% had an FLI ≥ 60. During median follow-up of 6.3 years, 45,143 cases of incident OSA occurred. In multivariable analysis, the risk of OSA was significantly higher in the higher FLI groups (adjusted hazard ratio [aHR] 1.15, 95% confidence interval [CI] 1.12–1.18 for FLI 30–60 and aHR 1.21, 95% CI 1.17–1.26 for FLI ≥ 60). These findings were consistent regardless of body mass index and presence of abdominal obesity. In conclusion, a high FLI score may help identify individuals with a high risk of OSA. Understanding the association between NAFLD and OSA may have clinical implications for risk-stratification of individuals with NAFLD.

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“…The most notable cluster analysis study done on OSA was the Icelandic Sleep Apnea Cohort (ISAC) that identified three subgroups-disturbed sleep group, minimally symptomatic group, and excessive daytime sleepiness group-using validated sleep-related questionnaires in addition to comorbid conditions [15]. Several other studies from Europe and Asia ensued clustering based on multiple polysomnography (PSG) variables, demographic factors, sleep-related symptoms, comorbidities, and some studies obtained similar results whereas others ended up with different clusters [16][17][18][19].…”

Section: Cimmentioning

confidence: 99%

Identifying Obstructive Sleep Apnea Subtypes and Its Correlation With Mood States

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Objective: It has been difficult to establish specific subtypes of obstructive sleep apnea (OSA) due to the heterogeneous nature of the disor- der. Previous studies have attempted to exact clinical subgroups or phenotypes of the disorder. However, the psychiatric impact of OSA has been often overlooked, and thus, this study used cluster analysis to examine subgroups of OSA incorporating mood states.Methods: This study is comprised of 346 adult OSA patients (apnea-hypopnea index, AHI≥5) who underwent polysomnography at Nowon Eulji Medical Center from January 2003 to November 2012. Their data also included validated self-report questionnaires that evaluate daytime sleepi- ness, sleep quality, morningness-eveningness, and mood states: Epworth Sleepiness Scale, Korean version of the Pittsburgh Sleep Quality In- dex (PSQI-K), Horne and Östberg Questionnaire, and Korean edition of Profile of Mood States (K-POMS), respectively. A K-means cluster analy- sis was performed to determine the optimal number of clusters and characteristics.Results: We identified three clusters: cluster 1, moderately symptomatic OSA with the least disturbed mood (n=166); cluster 2, severely symptomatic OSA not so disturbed mood (n=90); cluster 3, moderately symptomatic with highest disturbed mood (n=90). Cluster 1 had the lowest AHI and the lowest K-POMS total scores. Cluster 2, despite having the most severe OSA parameters, did not show mood disturbances. Cluster 3 had the highest K-POMS total scores and PSQI-K scores.Conclusion: Certain individuals with OSA are more likely to suffer from disturbed mood states without serious OSA indices. Psychiat- ric manifestations should also be considered when determining the severity of the disorder.

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Polysomnographic phenotyping of obstructive sleep apnea and its implications in mortality in Korea

Cited by 24 publications

References 48 publications

Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness

Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness

Nonalcoholic fatty liver disease is associated with the development of obstructive sleep apnea

Identifying Obstructive Sleep Apnea Subtypes and Its Correlation With Mood States

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