A Global Comparison of Anatomic Risk Factors and Their Relationship to Obstructive Sleep Apnea Severity in Clinical Samples

Sutherland, Kate; Keenan, Brendan T.; Bittencourt, Lia; Chen, Ning‐Hung; Gíslason, Þórarinn; Leinwand, Sarah E; Magalang, Ulysses J.; Maislin, Greg; Mazzotti, Diego R.; McArdle, Nigel; Mindel, Jesse; Pack, Allan I.; Penzel, Thomas; Singh, Bhajan; Tufik, Sérgio; Schwab, Richard J.; Cistulli, Peter A.

doi:10.5664/jcsm.7730

Cited by 51 publications

(34 citation statements)

References 54 publications

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“…De-identified data from consecutive subjects who underwent polysomnography (PSG) for clinical suspicion of OSA in six sleep centers of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) were included. 12,13 The retrospective study obtained approval from The Ohio State University Institutional Review Board (IRB protocol number 2014H0389).…”

Section: Retrospective Datasetmentioning

confidence: 99%

Defining Extreme Phenotypes of OSA Across International Sleep Centers

Rizzatti

Mazzotti

Mindel

et al. 2020

Chest

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BACKGROUND: Extreme phenotypes of OSA have not been systematically defined. RESEARCH QUESTION: This study developed objective definitions of extreme phenotypes of OSA by using a multivariate approach. The utility of these definitions for identifying characteristics that confer predisposition toward or protection against OSA is shown in a new prospective sample. STUDY DESIGN AND METHODS: In a large international sample, race-specific liability scores were calculated from a weighted logistic regression that included age, sex, and BMI. Extreme cases were defined as individuals with an apnea-hypopnea index (AHI) $ 30 events/hour but low likelihood of OSA based on age, sex, and BMI (liability scores > 90th percentile). Similarly, extreme controls were individuals with an AHI < 5 events/hour but high likelihood of OSA (liability scores < 10th percentile). Definitions were applied to a prospective sample from the Sleep Apnea Global Interdisciplinary Consortium, and differences in photographybased craniofacial and intraoral phenotypes were evaluated. RESULTS: This study included retrospective data from 81,338 individuals. A total of 4,168 extreme cases and 1,432 extreme controls were identified by using liability scores. Extreme cases were younger (43.1 AE 14.7 years), overweight (28.6 AE 6.8 kg/m 2), and predominantly female (71.1%). Extreme controls were older (53.8 AE 14.1 years), obese (34.0 AE 8.1 kg/m 2), and predominantly male (65.8%). These objective definitions identified 29 extreme cases and 87 extreme controls among 1,424 Sleep Apnea Global Interdisciplinary Consortium participants with photography-based phenotyping. Comparisons suggest that a greater cervicomental angle increases risk for OSA in the absence of clinical risk factors, and smaller facial widths are protective in the presence of clinical risk factors. INTERPRETATION: This objective definition can be applied in sleep centers throughout the world to consistently define OSA extreme phenotypes for future studies on genetic, anatomic, and physiologic pathways to OSA.

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Section: Retrospective Datasetmentioning

confidence: 99%

Defining Extreme Phenotypes of OSA Across International Sleep Centers

Rizzatti

Mazzotti

Mindel

et al. 2020

Chest

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“…Obesity has a reciprocal relationship with OSA, with weight gain worsening the condition and weight loss alleviating it, in the order of around a 30% change in AHI for 10% change in body weight . The majority of OSA patients in sleep clinics across the globe are overweight or obese . It is well recognised that obesity rates are rising globally, and this is driving a rise in OSA prevalence .…”

Section: Intermediate Osa Phenotypesmentioning

confidence: 99%

“…However, little is currently understood about these potential non‐anatomical neurohumoral mechanisms. Obesity may be more related to OSA severity in men compared with women and hence may be a stronger predictor of OSA presence in men, and the fat distribution patterns related to OSA (neck versus waist) appear to differ between genders . Additionally, there are ethnic differences in the effect of obesity on OSA severity .…”

Section: Intermediate Osa Phenotypesmentioning

confidence: 99%

“…Obesity may be more related to OSA severity in men compared with women and hence may be a stronger predictor of OSA presence in men, and the fat distribution patterns related to OSA (neck versus waist) appear to differ between genders . Additionally, there are ethnic differences in the effect of obesity on OSA severity . Asians require less weight gain, compared with Caucasians, to worsen OSA, while weight gain has least effect on OSA severity in African‐Americans .…”

Section: Intermediate Osa Phenotypesmentioning

confidence: 99%

“…Additionally, there are ethnic differences in the effect of obesity on OSA severity . Asians require less weight gain, compared with Caucasians, to worsen OSA, while weight gain has least effect on OSA severity in African‐Americans . Craniofacial structure interacts with the soft tissues, thereby playing a major role in moderating the effect of obesity.…”

Section: Intermediate Osa Phenotypesmentioning

confidence: 99%

See 2 more Smart Citations

Phenotyping obstructive sleep apnoea—Bringing precision to oral appliance therapy

Cistulli

Sutherland

2019

J of Oral Rehabilitation

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Obstructive Sleep Apnoea (OSA) is a highly prevalent disorder across the world and is characterised by repeated obstruction of the pharyngeal airway during sleep, resulting in oxygen desaturation (intermittent hypoxia) and sleep fragmentation. As awareness of the disorder has risen over the last few decades, there is growing recognition that OSA is a highly heterogeneous disorder, and that application of a precision medicine framework to its treatment could significantly enhance patient outcomes by allowing prediction of who has OSA, who needs it treated, who is susceptible to symptoms and comorbidities, which treatment should be used and who will respond to therapy. To achieve this, there is a need to develop an understanding of intermediate OSA phenotypes in terms of their contribution to disease pathogenesis, clinical and physiological expression and treatment responses. Recently, there have been an increasing number of studies using unsupervised (cluster) analytical approaches that have generated new insights, demonstrating the viability of a precision medicine approach in sleep medicine. These advances will undoubtedly influence the emerging field of dental sleep medicine, and dentists need to be aware of these developments.

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