Department of Pulmonary Medicine, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, 1000, Belgium.
Department of Pulmonary Medicine, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, 1020, Belgium.
Curr Med Sci. 2021 Aug;41(4):729-736. doi: 10.1007/s11596-021-2388-0. Epub 2021 Aug 17.
Several clinical obstructive sleep apnea syndrome (OSAS) phenotypes associated with heterogeneous cardiovascular risk profiles have been recently identified. The purpose of this study was to identify clusters amongst these profiles that allow for the differentiation of patients.
This retrospective study included all moderate-to-severe OSAS patients referred to the sleep unit over a 5-year period. Demographic, symptom, comorbidity, polysomnographic, and continuous positive airway pressure (CPAP) adherence data were collected. Statistical analyses were performed to identify clusters of patients.
A total of 567 patients were included (67% men, 54±13 years, body mass index: 32±7 kg/m, 65% Caucasian, 32% European African). Five clusters were identified: less severe OSAS (n=172); healthier severe OSAS (n=160); poorly sleeping OSAS patients with cardiometabolic comorbidities (n=87); younger obese men with sleepiness at the wheel (n=94); sleepy obese men with very severe desaturating OSAS and cardiometabolic comorbidities (n=54). Patients in clusters 3 and 5 were older than those in clusters 2 and 4 (P=0.034). Patients in clusters 4 and 5 were significantly more obese than those in the other clusters (P=0.04). No significant differences were detected in terms of symptoms and comorbidities. Polysomnographic profiles were very discriminating between clusters. CPAP adherence was similar in all clusters but, among adherent patients, daily usage was more important in cluster 1 (less severe patients) than in cluster 5.
This study highlights that the typical sleepy obese middle-aged men with desaturating events represent only a minority of patients in our multi-ethnic moderate-to-severe OSAS cohort of 33% females.
最近已经确定了几种与不同心血管风险特征相关的临床阻塞性睡眠呼吸暂停综合征（OSAS）表型。本研究的目的是在这些表型中识别出允许患者区分的聚类。
这项回顾性研究包括在 5 年内被转介到睡眠单位的所有中重度 OSAS 患者。收集了人口统计学、症状、合并症、多导睡眠图和持续气道正压通气（CPAP）依从性数据。进行了统计分析以确定患者聚类。
共纳入 567 例患者（67%为男性，54±13 岁，体重指数：32±7 kg/m，65%为白种人，32%为欧洲非洲人）。确定了五个聚类：较轻的 OSAS（n=172）；更严重的 OSAS 患者健康状况良好（n=160）；患有合并心血管代谢疾病的睡眠不佳的 OSAS 患者（n=87）；年轻肥胖且开车时嗜睡的男性（n=94）；患有严重低氧血症和心血管代谢合并症的肥胖嗜睡男性（n=54）。聚类 3 和 5 的患者比聚类 2 和 4 的患者年龄更大（P=0.034）。聚类 4 和 5 的患者比其他聚类的患者更肥胖（P=0.04）。在症状和合并症方面没有发现显著差异。多导睡眠图特征在聚类之间具有很强的区分能力。CPAP 依从性在所有聚类中都相似，但在依从性患者中，每天的使用在聚类 1（病情较轻的患者）比聚类 5 更为重要。
本研究表明，在我们的多民族中重度 OSAS 队列中，只有 33%的女性患者中，典型的嗜睡肥胖中年男性伴有低氧血症事件。
