Randerath Winfried J, Herkenrath Simon, Treml Marcel, Grote Ludger, Hedner Jan, Bonsignore Maria Rosaria, Pépin Jean Louis, Ryan Silke, Schiza Sophia, Verbraecken Johan, McNicholas Walter T, Pataka Athanasia, Sliwinski Pawel, Basoglu Özen K
Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany.
Dept of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.
ERJ Open Res. 2021 Mar 1;7(1). doi: 10.1183/23120541.00928-2020. eCollection 2021 Jan.
New findings on pathophysiology, epidemiology, and outcome have raised concerns on the relevance of the apnoea-hypopnoea index (AHI) in the classification of obstructive sleep apnoea (OSA) severity. Recently, a multicomponent grading system decision integrating symptomatology and comorbidities (Baveno classification), was proposed to characterise OSA and to guide therapeutic decisions. We evaluated whether this system reflects the OSA population, whether it translates into differences in outcomes, and whether the addition of AHI improves the scheme. A total of 14 499 OSA patients from the European Sleep Apnoea Database cohort were analysed. The groups were homogeneously distributed and were found to clearly stratify the population with respect to baseline parameters. Differences in sleepiness and blood pressure between the groups were analysed in a subgroup of patients after 24-36 months of treatment. Group A (minor symptoms and comorbidities) did not demonstrate any effect of treatment on outcome. However, groups B (severe symptoms, minor comorbidities), C (minor symptoms, severe comorbidities) and D (severe symptoms and comorbidities) were associated with improvement in either or both parameters with treatment. The AHI is an essential prerequisite of the diagnosis; however, adding the AHI did not improve the classification. Rather, it was inferior with respect to guiding the treatment decision. Thus, the Baveno classification allows a better stratification of the OSA population and may provide a better guidance for therapeutic decisions in OSA.
病理生理学、流行病学及预后方面的新发现引发了人们对于呼吸暂停低通气指数（AHI）在阻塞性睡眠呼吸暂停（OSA）严重程度分类中相关性的关注。最近，一种整合症状学和合并症的多组分分级系统决策（巴韦诺分类法）被提出来用于对OSA进行特征描述并指导治疗决策。我们评估了该系统是否能反映OSA人群情况，是否能转化为预后差异，以及加入AHI是否能改进该方案。对欧洲睡眠呼吸暂停数据库队列中的14499例OSA患者进行了分析。各分组分布均匀，且发现它们能根据基线参数对人群进行清晰分层。在24 - 36个月治疗后的一组患者亚组中分析了各分组之间嗜睡及血压的差异。A组（轻微症状和合并症）未显示出治疗对预后有任何影响。然而，B组（严重症状，轻微合并症）、C组（轻微症状，严重合并症）和D组（严重症状和合并症）在治疗后一个或两个参数均有改善。AHI是诊断的必要前提；然而，加入AHI并未改善分类。相反，在指导治疗决策方面它较差。因此，巴韦诺分类法能更好地对OSA人群进行分层，并且可能为OSA的治疗决策提供更好的指导。
