Relationship Between OSA Clinical Phenotypes and CPAP Treatment Outcomes

Gagnadoux, Frédéric; Vaillant, Marc Le; Paris, Audrey; Pigeanne, Thierry; Leclair-Visonneau, Laurence; Bizieux-Thaminy, Acya; Alizon, Claire; Humeau, Marie-Pierre; Nguyên, Xuân-Lan; Rouault, Béatrice; Trzépizur, Wojciech; Meslier, Nicole; Person, Christine; Priou, Pascaline; Goupil, F.; Molinier, Olivier; Breton, Philippe; Berkani, K; Langelot-Richard, Marie; Chollet, S.; Jaffré, S.; Corne, F.; Tranchade, Marc Normand de la; Racineux, Jean-Louis; Gosselin, Christelle; Pelletier‐Fleury, Nathalie

doi:10.1016/j.chest.2015.09.032

Cited by 114 publications

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“…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.…”

Section: Clinical Phenotypes Of Osamentioning

confidence: 99%

“…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.…”

Section: Clinical Phenotypes Of Osamentioning

confidence: 99%

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

et al. 2017

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In all fields of medicine, major efforts are currently dedicated to improve the clinical, physiological and therapeutic understanding of disease, and obstructive sleep apnoea (OSA) is no exception. The personalised medicine approach is relevant for OSA, given its complex pathophysiology and variable clinical presentation, the interactions with comorbid conditions and its possible contribution to poor outcomes. Treatment with continuous positive airway pressure (CPAP) is effective, but CPAP is poorly tolerated or not accepted in a considerable proportion of OSA patients. This review summarises the available studies on the physiological phenotypes of upper airway response to obstruction during sleep, and the clinical presentations of OSA ( phenotypes and clusters) with a special focus on our changing attitudes towards approaches to treatment. Such major efforts are likely to change and expand treatment options for OSA beyond the most common current choices (i.e. CPAP, mandibular advancement devices, positional treatment, lifestyle changes or upper airway surgery). More importantly, treatment for OSA may become more effective, being tailored to each patient's need.

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Section: Clinical Phenotypes Of Osamentioning

confidence: 99%

Section: Clinical Phenotypes Of Osamentioning

confidence: 99%

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

et al. 2017

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“…It is increasingly recognised that there is a between-sex difference in the clinical manifestations of OSA, with women more frequently experiencing symptoms of depression and anxiety, and less frequently complaining of excessive daytime sleepiness [11][12][13]. Sex differences have also been observed in cardiovascular outcomes, with more severe endothelial dysfunction [14], and higher risks of coronary heart disease and stroke in women [15].…”

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confidence: 93%

“…Further studies are required to evaluate the effects of CPAP therapy on cardiometabolic health in the context of weight-loss interventions for OSA patients with metabolic disorders. Personalised medicine is an emerging concept taking into account the marked heterogeneity of OSA in terms of structural and physiological risk factors, clinical phenotypes, molecular signatures, health outcomes, and treatment response [12,31,32]. A recent report demonstrated that blood pressure response to CPAP in OSA patients with resistant hypertension can be predicted by a cluster of three specific plasma microribonucleic acids [33].…”

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confidence: 99%

Effects of sleep apnoea therapy on blood pressure and metabolism: a CPAP sex gap?

et al. 2017

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Obstructive sleep apnoea (OSA) is a highly prevalent disease characterised by recurrent episodes of complete or partial upper airway obstruction during sleep, leading to intermittent hypoxia and sleep fragmentation. Most recent estimates of OSA prevalence suggest that 13% of men and 6% of women have clinically significant OSA [1, 2]. There is evidence from population-based and clinic-based cohort studies that moderate-to-severe OSA is independently associated with an increased incidence of cardiovascular events [3,4]. Besides OSA-related variables, comorbid conditions including hypertension and metabolic dysfunction play an important role in the development of cardiovascular diseases in OSA patients [4]. In the clinical setting, it has been estimated that at least half of patients with OSA fulfil the criteria for the metabolic syndrome [5]. Furthermore, the prevalence of metabolic syndrome increases with OSA severity [5,6]. An independent dose-response relationship has been demonstrated between OSA severity and the features of metabolic syndrome, including visceral adiposity [7], hypertension [8], metabolic dyslipidaemia [6] and impaired glucose metabolism [9,10]. Considering cardiovascular prevention as a therapeutic objective in OSA patients, it is crucial to determine whether OSA therapy can lead to clinically relevant improvements in blood pressure, and glucose and lipid metabolism.Most previous randomised controlled trials (RCTs) evaluating the impact of continuous positive airway pressure (CPAP) therapy on health outcomes were performed in unselected, predominantly male OSA patients. It is increasingly recognised that there is a between-sex difference in the clinical manifestations of OSA, with women more frequently experiencing symptoms of depression and anxiety, and less frequently complaining of excessive daytime sleepiness [11][12][13]. Sex differences have also been observed in cardiovascular outcomes, with more severe endothelial dysfunction [14], and higher risks of coronary heart disease and stroke in women [15]. Epidemiological data have shown that OSA in females is related to obesity, hypertension and diabetes but not to daytime sleepiness [11]. Altogether, these findings highlight the need for adequately powered RCTs examining sex differences in CPAP treatment response with particular focus on blood pressure and metabolic profile.

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“…Accordingly, the growing evidence obtained in males has been applied to females, taking for granted that the response to OSA treatment would be similar in the two sexes. However, we know that OSA differs between men and women in terms of prevalence, pathophysiology, severity, polysomnography findings and clinical presentation [4][5][6][7][8][9], and previous population-and clinic-based studies have found that the female phenotype of OSA is strongly associated with age, obesity and hypertension, but not with excessive daytime sleepiness [2,10].…”

Section: Introductionmentioning

confidence: 99%

Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea

et al. 2017

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Continuous positive airway pressure (CPAP) reduces blood pressure levels in hypertensive patients with obstructive sleep apnoea (OSA). However, the role of CPAP in blood pressure and the metabolic profile in women has not yet been assessed. In this study we investigated the effect of CPAP on blood pressure levels and the glucose and lipid profile in women with moderate-to-severe OSA.A multicentre, open-label, randomised controlled trial was conducted in 307 women diagnosed with moderate-to-severe OSA (apnoea-hypopnoea index ⩾15 events·h -1 ) in 19 Spanish Sleep Units. Women were randomised to CPAP (n=151) or conservative treatment (n=156) for 12 weeks. Changes in office blood pressure measures as well as in the glucose and lipid profile were assessed in both groups.Compared with the control group, the CPAP group achieved a significantly greater decrease in diastolic blood pressure (−2.04 mmHg, 95% CI −4.02-−0.05; p=0.045), and a nonsignificantly greater decrease in systolic blood pressure (−1.54 mmHg, 95% CI −4.58-1.51; p=0.32) and mean blood pressure (−1.90 mmHg, 95% CI −4.0-0.31; p=0.084). CPAP therapy did not change any of the metabolic variables assessed.In women with moderate-to-severe OSA, 12 weeks of CPAP therapy improved blood pressure, especially diastolic blood pressure, but did not change the metabolic profile, compared with conservative treatment.This article has supplementary material available from

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Relationship Between OSA Clinical Phenotypes and CPAP Treatment Outcomes

Cited by 114 publications

References 5 publications

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

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

Effects of sleep apnoea therapy on blood pressure and metabolism: a CPAP sex gap?

Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea

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