Changing Faces of Obstructive Sleep Apnea: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort

Abstract

Study objectives: Distinct clinical phenotypes of obstructive sleep apnea (OSA) have been identified: Disturbed Sleep, Minimally Symptomatic, and Sleepy. Determining whether these phenotypes respond differently to standard treatment helps us to create a foundation for personalized therapies. We compared responses to positive airway pressure (PAP) therapy in these clinical OSA phenotypes.

Methods: The study sample included 706 patients from the Icelandic Sleep Apnea Cohort with moderate-to-severe OSA who were prescribed PAP. Linear and logistic mixed models were used to compare 2-year changes in demographics, comorbid diseases, and sleep-related health issues within and across OSA clinical phenotypes. Relationships between changes in symptoms and PAP adherence were also examined.

Results: Overall, effect sizes were moderate to large when comparing sleepiness, insomnia-related, and apneic symptom changes in the Sleepy group with changes in other two groups, especially those in the Minimally Symptomatic group. Within the Disturbed Sleep group, PAP users and nonusers demonstrated similar changes in insomnia-related symptoms. The Minimally Symptomatic group remained relatively asymptomatic, but reported significant decreases in daytime sleepiness and physical fatigue; PAP users generally had larger improvements. The Sleepy group had reductions in nearly all measured symptoms, including large reductions in drowsy driving; almost all of these improvements were greater among PAP users than nonusers.

Conclusions: OSA treatment response patterns differed by initial clinical phenotype and PAP adherence. Individuals with insomnia-related symptoms may require additional targeted therapy for these complaints. These findings underscore the need for a personalized approach to management that recognizes patients with a range of OSA presentations.

Figure 1.

Symptom profiles in each cluster at baseline and follow-up. Radar plots are shown, illustrating the mean frequency scores reported by participants within the specified cluster for each indicated symptom at baseline and follow-up. Note the clear reduction in cluster-specific symptoms at follow-up.

Figure 2.

Follow-up symptom profiles in adherent and nonusers of PAP. Radar plots are shown, illustrating the follow-up symptom profile in PAP full users and nonusers separately for each cluster. Larger reductions in symptoms were generally seen for full users compared with nonusers. This effect was most pronounced in the Sleepy group, but also observed among Minimally Symptomatic patients. Nonusers reported modest improvements in symptoms at follow-up.