Teunissen Marion, Wielders Pascal, Bolman Catherine
Catharina Hospital, Department of Pulmonary Diseases, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands.
Department of Psychology, Open University of the Netherlands, Valkenburgerweg 177, Heerlen, 6419 AT, The Netherlands.
J Patient Rep Outcomes. 2025 Aug 18;9(1):104. doi: 10.1186/s41687-025-00915-z.
Although the group of patients with obstructive sleep apnea (OSA) is very heterogeneous, OSA's severity is mainly expressed by an apnea-hypopnea index (AHI), which does not correlate well with the experienced symptom severity. As a first step to develop a more personalized approach for treatment, the purpose of the current study was to create, through cluster analysis, meaningful OSA phenotypes linked to the Patient Reported Apnea Questionnaire (PRAQ).
Through a survey, new OSA patients indicated for continuous positive airway pressure (CPAP) treatment completed the Epworth Sleepiness Scale (ESS) and the PRAQ to rate their experienced symptom severity. Clinical data, such as the AHI and comorbidity, were assessed from the patient file. Cluster analysis has been performed to derive OSA phenotypes.
Based on the AHI, comorbidity and experienced symptom severity data of 151 patients, a two-step cluster analysis revealed five OSA phenotypes: "no comorbidity", "hypertension", "high symptom severity", "low symptom severity" and "unclassified". The five phenotypes mainly differ in the experienced level of fatigue, partner-observed snoring severity and symptoms related to performing regular daily activities.
Not only the AHI, but also comorbidity and subjective symptoms should be taken into consideration when diagnosing OSA, assessing its severity and in providing a more patient-oriented treatment, including deciding about CPAP treatment. Not the often-used ESS but the modified PRAQ scales provide relevant information to assess experienced symptom severity. In addition, for an improved prognostication, we propose an evaluation of the CPAP treatment effectiveness for the five reported OSA phenotypes.
尽管阻塞性睡眠呼吸暂停（OSA）患者群体非常异质，但OSA的严重程度主要由呼吸暂停低通气指数（AHI）来表示，而该指数与患者所经历的症状严重程度相关性不佳。作为开发更个性化治疗方法的第一步，本研究的目的是通过聚类分析创建与患者报告的呼吸暂停问卷（PRAQ）相关的有意义的OSA表型。
通过一项调查，新诊断为需持续气道正压通气（CPAP）治疗的OSA患者完成了爱泼华嗜睡量表（ESS）和PRAQ，以评估他们所经历的症状严重程度。从患者病历中评估临床数据，如AHI和合并症情况。进行聚类分析以得出OSA表型。
基于151例患者的AHI、合并症及所经历的症状严重程度数据，两步聚类分析揭示了五种OSA表型：“无合并症”、“高血压”、“高症状严重程度”、“低症状严重程度”和“未分类”。这五种表型在疲劳感受水平、伴侣观察到的打鼾严重程度以及与日常常规活动相关的症状方面存在主要差异。
在诊断OSA、评估其严重程度以及提供更以患者为导向的治疗（包括决定是否进行CPAP治疗）时，不仅应考虑AHI，还应考虑合并症和主观症状。并非常用的ESS，而是改良后的PRAQ量表提供了评估所经历症状严重程度的相关信息。此外，为了改善预后，我们建议对所报告的五种OSA表型评估CPAP治疗效果。
