Department of Respiratory Medicine, Prana Clinic, Saitama, Japan.
Hokkaido Institute of Respiratory Diseases, Hokkaido, Japan.
J Clin Sleep Med. 2022 Mar 1;18(3):895-902. doi: 10.5664/jcsm.9752.
In an attempt to better understand the heterogeneity of individuals with obstructive sleep apnea (OSA), unbiased analytic approaches such as cluster analysis have been used worldwide; however, only a few such studies have been conducted for Asian populations alone, despite the potential racial/ethnic differences. We thus applied this approach to a Japanese population with OSA.
In this single-center, retrospective, observational study, our nocturnal polysomnography dataset included the findings for 1,020 patients between May 2016 and December 2020. Of these, 712 patients met the study criteria: aged > 20 years, fully completed questionnaire, no missing data on all-night full polysomnography, and confirmed OSA diagnosis with an apnea-hypopnea index (AHI) > 15 events/h. We employed hierarchical cluster analysis using demographic data, self-reported symptoms, and polysomnographic data.
We identified 5 distinct clinical clusters within the OSA patient population, which were labeled as "classic OSA" (20--67 years, obese, high AHI, high Epworth Sleepiness Scale [ESS]), "milder classic OSA" (22--77 years, obese, high AHI, low ESS), "nonobese and minimally symptomatic" (20--88 years, moderate AHI, low ESS), "excessive sleepiness without severe OSA" (26--79 years, moderate AHI, high ESS), and "older adult and severe OSA" 55--92 years, (high AHI, low ESS). Of these, the last 3 clusters were characterized as nonobese. Notably, we identified the cluster with excessive sleepiness despite less severe OSA. We did not identify any clusters with predominant upper-airway obstruction symptoms because the symptoms were prevalent and equally distributed in all clusters.
We found some unique clinical phenotypes in nonobese patients with OSA in a Japanese population.
Ida H, Suga T, Nishimura M, Aoki Y. Unique clinical phenotypes of patients with obstructive sleep apnea in a Japanese population: a cluster analysis. 2022;18(3):895-902.
为了更好地了解阻塞性睡眠呼吸暂停（OSA）患者的异质性，全球范围内采用了无偏倚的分析方法，如聚类分析；然而，尽管存在潜在的种族/民族差异，仅有少数此类研究针对亚洲人群进行。因此，我们将这种方法应用于日本 OSA 人群。
在这项单中心、回顾性、观察性研究中，我们的夜间多导睡眠图数据集包括 2016 年 5 月至 2020 年 12 月期间的 1020 例患者的结果。其中，712 例患者符合研究标准：年龄＞20 岁，完整完成问卷，整夜全睡眠多导图无缺失数据，并且呼吸暂停低通气指数（AHI）＞15 次/小时确诊为 OSA。我们使用人口统计学数据、自我报告的症状和睡眠图数据进行层次聚类分析。
我们在 OSA 患者人群中发现了 5 个不同的临床聚类，分别标记为“经典 OSA”（20-67 岁，肥胖，高 AHI，高 Epworth 睡眠量表[ESS]）、“较轻的经典 OSA”（22-77 岁，肥胖，高 AHI，低 ESS）、“非肥胖和症状轻微”（20-88 岁，中度 AHI，低 ESS）、“无严重 OSA 但过度嗜睡”（26-79 岁，中度 AHI，高 ESS）和“老年和严重 OSA”（55-92 岁，高 AHI，低 ESS）。其中，后 3 个聚类表现为非肥胖。值得注意的是，我们发现了即使 OSA 不严重但仍存在过度嗜睡的聚类。我们没有发现任何以主要上气道阻塞症状为特征的聚类，因为这些症状在所有聚类中都普遍存在且分布均匀。
我们在日本人群中发现了一些非肥胖 OSA 患者的独特临床表型。
Ida H, Suga T, Nishimura M, Aoki Y. 日本人群阻塞性睡眠呼吸暂停患者的独特临床表型：聚类分析。2022;18(3):895-902.
