Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness

Abstract

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.

Keywords: CPAP; cluster; obstructive sleep apnea; phenotype; treatment effectiveness.

Figure 1

Selection of study subjects. Abbreviation: CPAP - continuous positive airway pressure, OSA–obstructive sleep apnea.

Figure 2

Dendrogram, which indicates 3 distinct main clusters.

Figure 3

Treatment effectiveness according to phenotypes. Response to treatment is shown in 3 different levels. ΔAHI indicates apnea-hypopnea index rate after treatment with CPAP. Abbreviations: OSA–obstructive sleep apnea, PLM–periodic limb movements, CPAP–continuous positive airway pressure.