Baseline clusters and the response to positive airway pressure treatment in obstructive sleep apnoea patients: longitudinal data from the European Sleep Apnea Database cohort.

Autor:	Yassen A; Pharmacometrics/Modeling and Simulation, Research and Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany.; Joint first authors., Coboeken K; Pharmacometrics/Modeling and Simulation, Research and Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany.; Joint first authors., Bailly S; University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France., Burghaus R; Pharmacometrics/Modeling and Simulation, Research and Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany., Buskova J; National Institute of Mental Health, Klecany, Czech Republic., Dogas Z; Department of Neuroscience, Sleep Medicine Center, University of Split School of Medicine, Split, Croatia., Drummond M; Sleep and Non-Invasive Ventilation Unit of University Hospital São João, Medicine Faculty of Porto, Porto, Portugal., Gouveris H; ENT Department at Mainz University Hospital, Mainz, Germany., Joppa P; Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University and L. Pasteur University Hospital, Kosice, Slovakia., Lippert J; Pharmacometrics/Modeling and Simulation, Research and Development, Pharmaceuticals, Bayer AG, Leverkusen, Germany., Lombardi C; Istituto Auxologico Italiano IRCCS, Sleep Disorders Center, San Luca Hospital, Milan, Italy.; Departmed of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Mihaicuta S; Centre for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, 'Victor Babes' University of Medicine and Pharmacy, CardioPrevent Foundation, Timisoara, Romania., Pépin JL; University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France., Zou D; Department of Internal Medicine and Clinical Nutrition, Center for Sleep and Wake Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Hedner J; Department of Internal Medicine and Clinical Nutrition, Center for Sleep and Wake Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Pulmonary Medicine, Sleep Disorders Center, Sahlgrenska University Hospital, Gothenburg, Sweden.; Joint senior authors., Grote L; Department of Internal Medicine and Clinical Nutrition, Center for Sleep and Wake Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Pulmonary Medicine, Sleep Disorders Center, Sahlgrenska University Hospital, Gothenburg, Sweden.; Joint first authors.
Jazyk:	angličtina
Zdroj:	ERJ open research [ERJ Open Res] 2022 Oct 31; Vol. 8 (4). Date of Electronic Publication: 2022 Oct 31 (Print Publication: 2022).
DOI:	10.1183/23120541.00132-2022
Abstrakt:	Introduction: The European Sleep Apnea Database was used to identify distinguishable obstructive sleep apnoea (OSA) phenotypes and to investigate the clinical outcome during positive airway pressure (PAP) treatment. Method: Prospective OSA patient data were recruited from 35 sleep clinics in 21 European countries. Unsupervised cluster analysis (anthropometrics, clinical variables) was performed in a random sample (n=5000). Subsequently, all patients were assigned to the clusters using a conditional inference tree classifier. Responses to PAP treatment change in apnoea severity and Epworth sleepiness scale (ESS) were assessed in relation to baseline patient clusters and at short- and long-term follow-up. Results: At baseline, 20 164 patients were assigned (mean age 54.1±12.2 years, 73% male, median apnoea-hypopnoea index (AHI) 27.3 (interquartile range (IQR) 14.1-49.3) events·h -1 , and ESS 9.8±5.3) to seven distinct clusters based on anthropometrics, comorbidities and symptoms. At PAP follow-up (median 210 [IQR 134-465] days), the observed AHI reduction (n=1075) was similar, whereas the ESS response (n=3938) varied: largest reduction in cluster 3 (young healthy symptomatic males) and 6 (symptomatic males with psychiatric disorders, -5.0 and -5.1 units, respectively (all p<0.01), limited reduction in clusters 2 (obese males with systemic hypertension) and 5 (elderly multimorbid obese males, -4.2 (p<0.05) and -3.7 (p<0.001), respectively). Residual sleepiness in cluster 5 was particularly evident at long-term follow-up (p<0.05). Conclusion: OSA patients can be classified into clusters based on clinically identifiable features. Importantly, these clusters may be useful for prediction of both short- and long-term responses to PAP intervention. Competing Interests: Conflict of interest: A. Yassen, K. Coboeken, R. Burghaus and J. Lipper are employees of Bayer AG. The ESADA network received a research grant from Bayer for the conduct of the study as well as enabling grants from RESMED and Philips Foundation outside the submitted work. J.L. Pépen has no conflict of interest about the submitted work. Outside the work he has received the following: grants/research support from Resmed, Philips, Fisher and Paykel, Agiradom, Astra Zeneca, Mutualia (research support), Vitalaire Air Liquide Foundation (research support) and SEFAM; honoraria or consultation fees from Resmed, Philips, Agiradom, AstraZeneca, JAZZ, ITAMAR, SEFAM and Bioprojet. J. Hedner has received grants from Itamar Medical, Resmed, Philips, AstraZeneca and Desitin outside the submitted work. J. Hedner is part owner of a licensed patent dealing with sleep apnoea therapy. L. Grote reports nonfinancial and other support from Itamar Medical, Resmed, Philips, AstraZeneca, Breas and Desitin outside the submitted work. In addition, L. Grote reports ownership in a patent on sleep apnoea therapy licensed. All remaining authors report no conflict of interest. (Copyright ©The authors 2022.)
Databáze:	MEDLINE
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