Matthes Sandhya, Treml Marcel, Grote Ludger, Hedner Jan, Zou Ding, Bonsignore Maria R, Pépin Jean-Louis, Bailly Sébastien, Ryan Silke, McNicholas Walter T, Schiza Sofia E, Verbraecken Johan, Pataka Athanasia, Śliwiński Paweł, Basoglu Özen K, Lombardi Carolina, Parati Gianfranco, Randerath Winfried J
Bethanien Hospital, Institute for Pneumology at the University of Cologne, Solingen, Germany.
Centre for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Eur Respir J. 2024 Dec 12;64(6). doi: 10.1183/13993003.01371-2024. Print 2024 Dec.
The "Baveno classification" replaced the apnoea-hypopnoea index (AHI) with symptoms and comorbidities for treatment indication in obstructive sleep apnoea (OSA). This study evaluates a modified Baveno classification which adds a validated cardiovascular disease (CVD) risk score and acknowledges severe breathing disturbances.
OSA patients from the European Sleep Apnoea Database (ESADA) were retrospectively allocated into CVD risk groups 1-3 based on the SCORE2 risk prediction model and European Society of Cardiology guidelines. AHI ≥30 events·h conferred strong treatment indication. When AHI was <30 events·h, symptoms and CVD risk dictated allocation to the weak, intermediate or strong treatment indication group. Changes in Epworth Sleepiness Scale (ESS) score and office systolic blood pressure (SBP) at follow-up (12-24 months) under positive airway pressure (PAP) were assessed.
8625 patients were analysed (29% female; median (interquartile range) age 56 (49-64) years and body mass index 31.9 (28.4-36.3) kg·m). Treatment indication was weak in 501 (6%), intermediate in 2085 (24%) and strong in 6039 (70%). There was a continuous increase in age, SBP, C-reactive protein and glycosylated haemoglobin from weak to strong (p<0.001). PAP prescription increased from 52% to 64% to 93% (weak to strong; p<0.001). The change in ESS score was -2, -4 and -5, respectively (p<0.001). Reductions of ≥3 mmHg median SBP occurred when AHI was ≥30 events·h and in symptomatic patients with CVD risk levels >1 when AHI was <30 events·h.
This analysis provides supporting evidence for the key role of CVD risk assessment and severe breathing disturbances in the identification of OSA patients most likely to benefit from treatment.
“巴韦诺分类法”用症状和合并症取代呼吸暂停低通气指数（AHI）来指导阻塞性睡眠呼吸暂停（OSA）的治疗。本研究评估了一种改良的巴韦诺分类法，该分类法增加了经过验证的心血管疾病（CVD）风险评分，并认可严重呼吸紊乱。
基于SCORE2风险预测模型和欧洲心脏病学会指南，将欧洲睡眠呼吸暂停数据库（ESADA）中的OSA患者回顾性地分为CVD风险1 - 3组。AHI≥30次/小时表明有强烈的治疗指征。当AHI<30次/小时时，症状和CVD风险决定患者被分配到弱、中或强治疗指征组。评估了在接受气道正压通气（PAP）治疗随访（12 - 24个月）时，爱泼沃斯嗜睡量表（ESS）评分和诊室收缩压（SBP）的变化。
共分析了8625例患者（29%为女性；年龄中位数（四分位间距）为56（49 - 64）岁；体重指数为31.9（28.4 - 36.3）kg/m²）。治疗指征为弱的有501例（6%），中等的有2085例（24%），强的有6039例（70%）。从弱到强，年龄、SBP、C反应蛋白和糖化血红蛋白持续增加（p<0.001）。PAP处方率从52%增至64%再增至93%（从弱到强；p<0.001）。ESS评分变化分别为 - 2、 - 4和 - 5（p<0.001）。当AHI≥30次/小时以及AHI<30次/小时且有CVD风险水平>1的有症状患者中，SBP中位数降低≥3 mmHg。
本分析为CVD风险评估和严重呼吸紊乱在识别最可能从治疗中获益的OSA患者方面的关键作用提供了支持性证据。
