Sousa Sofia Rodrigues, Caldeira João Nunes, Moita Joaquim
Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Adv Respir Med. 2022 Feb 24. doi: 10.5603/ARM.a2022.0028.
The classification of the severity of obstructive sleep apnea (OSA) based on the Apnea/Hypopnea Index (AHI) does not reflect the heterogeneity and prognosis of the disease. The Baveno classification proposes a new assessment system that includes symptoms and comorbidities. The aim of our study was to evaluate the application of the Baveno classification in clinical practice and to explore its association with sleep indices, adherence to therapy and symptoms over a 6-months period.
Prospective study including patients diagnosed with OSA between January and July 2021 was conducted. Patients were divided into 4 groups (A-D) according to the Baveno classification. The adherence to PAP treatment and Epworth Sleepiness Scale (ESS) values were obtained 6 months after initiation of therapy.
A total of 91 patients (84% male, 58 ± 13 years) were included in the study. The median ESS score was 10 (6-15), mean AHI was 28.4 ± 22.2 events/hour and the time with SpO₂ < 90% (T90) was 9.7 ± 14.9%. At diagnosis, patients were classified into Baveno groups: A: 30%; B: 35%; C: 17%, D: 19%. There were no statistical differences in AHI between the different groups. On the other hand, T90 had higher values in patients with comorbidities (C, D). Regarding the treatment, the prescription of PAP was higher in patients with comorbidities (C, D), and adherence to this treatment at 6 months was higher in group D. Among patients under PAP therapy, there was a statistically significant decrease in daytime sleepiness at 6 months in groups B and D.
The Baveno classification distributes patients with OSA evenly across the different phenotypes, regardless of the AHI value. The treatment decision was linked to the comorbidities (C, D) were the ones who had the greatest adherence to treatment at 6 months were in group D. ESS improved with greater emphasis in the most symptomatic (B, D), while the AHI is essential for the diagnosis of OSA, the Baveno classification may guide physicians better in their treatment decision.
基于呼吸暂停/低通气指数（AHI）对阻塞性睡眠呼吸暂停（OSA）严重程度进行分类并不能反映该疾病的异质性和预后情况。巴韦诺分类法提出了一种新的评估系统，该系统纳入了症状和合并症。我们研究的目的是评估巴韦诺分类法在临床实践中的应用，并探讨其与睡眠指标、治疗依从性以及6个月期间症状的相关性。
开展了一项前瞻性研究，纳入2021年1月至7月期间被诊断为OSA的患者。根据巴韦诺分类法将患者分为4组（A - D）。在开始治疗6个月后获取持续气道正压通气（PAP）治疗的依从性以及爱泼华嗜睡量表（ESS）值。
共有91名患者（84%为男性，年龄58±13岁）纳入研究。ESS评分中位数为10（6 - 15），平均AHI为28.4±22.2次/小时，血氧饱和度<90%的时间（T90）为9.7±14.9%。诊断时，患者被分为巴韦诺组：A组：30%；B组：35%；C组：17%，D组：19%。不同组之间的AHI无统计学差异。另一方面，合并症患者（C组、D组）的T90值更高。关于治疗，合并症患者（C组、D组）的PAP处方率更高，D组在6个月时对该治疗的依从性更高。在接受PAP治疗的患者中，B组和D组在6个月时白天嗜睡情况有统计学意义的下降。
巴韦诺分类法将OSA患者均匀地分布在不同表型中，而不考虑AHI值。治疗决策与合并症相关（C组、D组），D组是6个月时治疗依从性最高的组。ESS在症状最明显的患者（B组、D组）中改善更为显著，虽然AHI对OSA的诊断至关重要，但巴韦诺分类法可能会在治疗决策方面为医生提供更好的指导。
