TY - JOUR
T1 - Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers
T2 - A cluster analysis
AU - Keenan, Brendan T.
AU - Kim, Jinyoung
AU - Singh, Bhajan
AU - Bittencourt, Lia
AU - Chen, Ning Hung
AU - Cistulli, Peter A.
AU - Magalang, Ulysses J.
AU - McArdle, Nigel
AU - Mindel, Jesse W.
AU - Benediktsdottir, Bryndis
AU - Arnardottir, Erna Sif
AU - Prochnow, Lisa Kristin
AU - Penzel, Thomas
AU - Sanner, Bernd
AU - Schwab, Richard J.
AU - Shin, Chol
AU - Sutherland, Kate
AU - Tufik, Sergio
AU - Maislin, Greg
AU - Gislason, Thorarinn
AU - Pack, Allan I.
N1 - Funding Information:
Research at the University of Pennsylvania was supported by a Program Project Grant from the National Institutes of Health (P01 HL094307). Dr. Bittencourt has a grant number 401569/2016-0 from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). The project was also supported by Award Number Grant UL1TR001070 from the National Center For Advancing Translational Sciences; the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Advancing Translational Sciences or the National Institutes of Health.
Publisher Copyright:
© Sleep Research Society 2018.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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.
AB - 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.
KW - disease subtypes
KW - excessive sleepiness
KW - insomnia
KW - minimally symptomatic
KW - obstructive sleep apnea
KW - personalized medicine
UR - http://www.scopus.com/inward/record.url?scp=85043603117&partnerID=8YFLogxK
U2 - 10.1093/sleep/zsx214
DO - 10.1093/sleep/zsx214
M3 - Article
C2 - 29315434
AN - SCOPUS:85043603117
VL - 41
JO - Sleep
JF - Sleep
SN - 0161-8105
IS - 3
ER -