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Review
. 2020 Mar 20;17(6):2058.
doi: 10.3390/ijerph17062058.

Qualitative Phenotyping of Obstructive Sleep Apnea and Its Clinical Usefulness for the Sleep Specialist

Marcello Bosi  1 , Andrea De Vito  2 , Danny Eckert  3 , Joerg Steier  4   5 , Bhik Kotecha  6 , Claudio Vicini  7   8   9 , Venerino Poletti  1   10
Affiliations
Review

Qualitative Phenotyping of Obstructive Sleep Apnea and Its Clinical Usefulness for the Sleep Specialist

Marcello Bosi et al. Int J Environ Res Public Health. .

Abstract

Introduction: The anatomical collapsibility of the upper airway, neuromuscular tone and function, sleep-wake and ventilatory control instability, and the arousal threshold all interact and contribute to certain pathophysiologic features that characterize different types of obstructive sleep apnea (OSA). A model of qualitative phenotypizationallowsus to characterize the different pathophysiological traits in OSA patients.

Methods: A narrative review was performed, to analyze the available literature evidence, with the purpose of generating a model of qualitative phenotypization to characterize pathophysiological traits in patients with OSA.

Results: 96 out of 3829 abstracts were selected for full-text review. Qualitative phenotyping model of OSA:Data concerning the OSA qualitative pathophysiological traits' measurement can be deducted by means of clinical PSG, grade of OSA severity, and therapeutic level of Continuous Positive Airway Pressure (CPAP) and are reported in the text. This approach would allow qualitative phenotyping with widely accessible methodology in a routine clinical scenario and is of particular interest for the sleep specialist, surgical treatment decision-making, and customized OSA multimodality treatment.

Keywords: CPAP; obstructive sleep apnea; pathophysiological traits; phenotypization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Relationship between UA Collapsibility and other PTs. Patient (a) has no UA collapse and does not develop OSA, even if the other PTs are impaired. Patient (b1) has a severe UA collapsibility and develops OSA even if the other PTs are normal. Patient (b2) has an intermediate level of UA collapsibility. Patient (b3) has a mild degree of UA collapsibility and develops OSA only if the other PTs are significantly impaired. Legend: AT: arousal threshold; LG: loop gain; UAG: upper airway gain; OSA: obstructive sleep apnea.
Figure 2
Figure 2
(a) Surgical treatment of the upper airways (UA) achieves complete resolution of UA collapsibility, and the patient is cured independent of any other pathophysiological trait (PT) grade. (b) Surgical treatment of the UA significantly improves pharyngeal collapsibility up to a low grade of collapsibility. In this model, any complete resolution of apneic events or the persistence of OSA are caused by confounding PT. (c) Surgical treatment of the UA does not achieve any significant improvement of pharyngeal collapsibility, which remains of high grade, and obstructive sleep apnea (OSA) does not improve. Legend: PALM: Pcrit, AT: arousal threshold; LG: loop gain; UAG: upper airway gain; OSA: obstructive sleep apnea, PT: pathophysiological trait.
Figure 3
Figure 3
Predominantly obstructive apneic events (OSA). OSA with more than 90% of the respiratory events are obstructive apneas, characterized by a high UA collapsibility. Legend: OSA: obstructive sleep apnea; UA: upper airways.
Figure 4
Figure 4
UARS is characterized by low UA collapsibility. Airflow is slightly limited with ever-increasing respiratory effort, until arousal from sleep occurs. No arterial desaturations are observed with RERAs, but these respiratory events lead to sleep fragmentation. Legend: UARS: upper airways resistance syndrome; UA: upper airways; RERA: respiratory-effort-related arousals.
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References

    1. Young T., Palta M., Dempsey J., Skatrud S., Weber J., Badr S. The occurrence of sleep disordered breathing among middle-aged adults. N. Engl. J. Med. 1993;328:1230–1235. doi: 10.1056/NEJM199304293281704. - DOI - PubMed
    1. Roehrs T., Zorick F., Wittig R., Conway W.A., Roth T. Predictors of level of daytime sleepiness in patients with sleep- related breathing disorders. Chest. 1989;95:1202–1206. doi: 10.1378/chest.95.6.1202. - DOI - PubMed
    1. Colt H., Haas H., Rich G. Hypoxemia vs sleep fragmenta- tion as cause of excessive daytime sleepiness in obstructive apnea. Chest. 1991;100:1542–1548. doi: 10.1378/chest.100.6.1542. - DOI - PubMed
    1. Fulda S., Shulz H. Cognitive dysfunction in sleep disorders. Sleep Med. Rev. 2001;5:423–445. doi: 10.1053/smrv.2001.0157. - DOI - PubMed
    1. Beebe D., Gozal D. Obstructive sleep apnea and the pre- frontal cortex: Towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J. Sleep Res. 2002;11:1–16. doi: 10.1046/j.1365-2869.2002.00289.x. - DOI - PubMed

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