Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: A cluster analysis

Brendan T. Keenan, Jinyoung Kim, Bhajan Singh, Lia Bittencourt, Ning Hung Chen, Peter A. Cistulli, Ulysses J. Magalang, Nigel McArdle, Jesse W. Mindel, Bryndis Benediktsdottir, Erna Sif Arnardottir, Lisa Kristin Prochnow, Thomas Penzel, Bernd Sanner, Richard J. Schwab, Chol Shin, Kate Sutherland, Sergio Tufik, Greg Maislin, Thorarinn GislasonAllan I. Pack

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Abstract

Study Objectives A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m 2), and had severe OSA (42.0-51.4 events per hour) on average. Conclusions Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.

Original languageEnglish
JournalSleep
Volume41
Issue number3
DOIs
Publication statusPublished - 2018 Mar 1

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Keywords

  • disease subtypes
  • excessive sleepiness
  • insomnia
  • minimally symptomatic
  • obstructive sleep apnea
  • personalized medicine

ASJC Scopus subject areas

  • Clinical Neurology
  • Physiology (medical)

Cite this

Keenan, B. T., Kim, J., Singh, B., Bittencourt, L., Chen, N. H., Cistulli, P. A., Magalang, U. J., McArdle, N., Mindel, J. W., Benediktsdottir, B., Arnardottir, E. S., Prochnow, L. K., Penzel, T., Sanner, B., Schwab, R. J., Shin, C., Sutherland, K., Tufik, S., Maislin, G., ... Pack, A. I. (2018). Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: A cluster analysis. Sleep, 41(3). https://doi.org/10.1093/sleep/zsx214