Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.
School of Nursing, University of Pennsylvania, Philadelphia, PA.
Sleep. 2018 Mar 1;41(3). doi: 10.1093/sleep/zsx214.
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.
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.
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/m2), and had severe OSA (42.0-51.4 events per hour) on average.
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.
最近冰岛一项针对中重度阻塞性睡眠呼吸暂停（OSA）患者的研究基于症状和合并症确定了三个临床聚类。我们试图在冰岛的一个新队列中验证这一发现，并在一个国际多种族队列中检验 OSA 聚类的普遍性。
使用睡眠呼吸暂停全球跨学科联盟（SAGIC）招募的 972 名中重度 OSA（呼吸暂停低通气指数[AHI]≥15 次/小时）患者的数据，我们对 18 项自我报告的症状变量、高血压、心血管疾病和糖尿病进行了潜在类别分析。
在来自冰岛的 215 名 SAGIC 患者中，睡眠障碍、轻度症状和过度嗜睡的 OSA 聚类复制。这些聚类也适用于来自其他五个国家的 757 名患者。在冰岛和国际样本中，这三个聚类的平均 AHI 值相似，这表明聚类不是由 OSA 严重程度驱动的；年龄、性别和体重指数的差异通常也较小。在国际样本中，这三个原始聚类扩展到五个最佳聚类：三个与冰岛相似（命名为睡眠障碍、轻度症状和上气道症状伴嗜睡），两个是新的、症状较轻的聚类（命名为上气道症状为主和嗜睡为主）。这五个聚类在人口统计学和 AHI 方面存在差异，尽管所有聚类的年龄均为中年（44.6-54.5 岁）、肥胖（30.6-35.9kg/m2），且平均患有严重 OSA（42.0-51.4 次/小时）。
结果证实并扩展了之前在 OSA 中确定的临床聚类。这些聚类为 OSA 的管理提供了一种更个性化的方法。
