Incorporating polysomnography into obstructive sleep apnoea phenotyping: moving towards personalised medicine for OSA

Pépin, Jean‐Louis; Bailly, Sébastien; Tamisier, Renaud

doi:10.1136/thoraxjnl-2017-210943

Cited by 23 publications

(21 citation statements)

References 20 publications

(24 reference statements)

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“…Although the possible protective role of OSA treatment is still uncertain, it could differ among different clinical phenotypes of OSA patients. In that regard, studies are still moving their first steps [18, 175], but some data are available showing different responses depending on OSA phenotype [19]. Such view is confirmed by the recent report developed by European experts on OSA, which suggests that both symptoms and organ damage should be considered when choosing the appropriate treatment for OSA [174].…”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea and comorbidities: a dangerous liaison

Bonsignore

Baiamonte

Mazzuca

et al. 2019

Multidiscip Respir Med

178

116

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Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.

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Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea and comorbidities: a dangerous liaison

Bonsignore

Baiamonte

Mazzuca

et al. 2019

Multidiscip Respir Med

178

116

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“…Nocturnal sweating is a marker of high nocturnal sympathetic activity and might represent associated comorbidities and poor sleep quality. The role of restless leg syndrome and periodic leg movements is important and the association of obstructive sleep apnoea with PLMs/poor sleep has been recently shown to be a deadly association for cardiovascular diseases 22,23 . Our data complement this observation by showing that this OSA-PLMs phenotype is also at high risk of sleepiness-related accidents, a finding that should be considered for the purpose of risk stratification in clinical practice 24 .…”

Section: Discussionmentioning

confidence: 99%

Self-reported sleepiness and not the apnoea hypopnoea index is the best predictor of sleepiness-related accidents in obstructive sleep apnoea

Philip

Bailly

Benmerad

et al. 2020

Sci Rep

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To evaluate the value of apnoea + hypopnoea index versus self-reported sleepiness at the wheel in anticipating the risk of sleepiness-related accidents in patients referred for obstructive sleep apnoea. A cross-sectional analysis of the French national obstructive sleep apnoea registry. 58,815 subjects referred for a suspicion of obstructive sleep apnoea were investigated by specific items addressing sleepiness at the wheel and sleepiness-related accidents. Apnoea + hypopnoea index was evaluated with a respiratory polygraphy or full polysomnography. Subjects had a median age of 55.6 years [45.3; 64.6], 65% were men, with a median apnoea + hypopnoea index of 22 [8; 39] events/h. Median Epworth sleepiness scale score was 9 [6; 13], 35% of the patients reported sleepiness at the wheel (n = 20,310), 8% (n = 4,588) reported a near-miss accident and 2% (n = 1,313) reported a sleepiness-related accident. Patients reporting sleepiness at the wheel whatever their obstructive sleep apnoea status and severity exhibited a tenfold higher risk of sleepiness-related accidents. In multivariate analysis, other predictors for sleepiness-related accidents were: male gender, ESS, history of previous near-miss accidents, restless leg syndrome/periodic leg movements, complaints of memory dysfunction and nocturnal sweating. Sleep apnoea per se was not an independent contributor. Self-reported sleepiness at the wheel is a better predictor of sleepiness-related traffic accidents than apnoea + hypopnoea index.

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“…Only half of the OSA patients are symptomatic and a significant percentage of subjects are referred and treated with the goal of mitigating their cardiometabolic risk. The co‐morbidities are of major importance because they have a significant impact on OSA patients' healthcare use and mortality . Continuous positive airway pressure (CPAP), the first‐line therapy for OSA, is highly effective in terms of symptom improvement even in minimally symptomatic patients who initially complain of fatigue and non‐restorative sleep .…”

Section: Introductionmentioning

confidence: 99%

“…The co-morbidities are of major importance because they have a significant impact on OSA patients' healthcare use and mortality. 3,4 Continuous positive airway pressure (CPAP), the first-line therapy for OSA, is highly effective in terms of symptom improvement even in minimally symptomatic patients who initially complain of fatigue and nonrestorative sleep. 5 CPAP has a limited impact on the reduction in the burden of co-morbidities, 6 and comorbidities might affect the effectiveness of CPAP to normalize the apnoea-hypopnoea index (AHI) and may hinder CPAP adherence.…”

Section: Introductionmentioning

confidence: 99%

Partial failure of CPAP treatment for sleep apnoea: Analysis of the French national sleep database

et al. 2019

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Background and objective Continuous positive airway pressure (CPAP) is the first‐line therapy for obstructive sleep apnoea (OSA). Residual apnoea and/or hypopnoea events, that is an apnoea–hypopnoea index (AHI) > 5, during CPAP contribute to treatment drop‐out. The clinical scenarios triggering residual events during CPAP use are poorly described. Underlying co‐morbidities, especially cardiovascular diseases, lifestyle factors, OSA characteristics at diagnosis and type of mask have been suggested as potential contributors. Methods Patients from the prospective French sleep apnoea registry diagnosed with OSA (AHI ≥ 15 events/h) treated with CPAP were included. Logistic regression analysis identified factors associated with a risk of residual AHI > 5 events/h on CPAP. Results The 12 285 OSA patients were predominantly men (n = 8715, 70.9%), middle‐aged (58.2 (49.8; 66.1) years) and obese (median body mass index: 31.3 (27.7; 35.6) kg/m2). Most had an AHI ≤ 5 events/h (n = 9573, 77.9%) versus 22.1% with AHI > 5/h. The latter were less CPAP adherent (5.75 (4.01; 7.00) vs 6.00 (4.53; 7.00) h/night). In multivariable analysis, factors associated with residual AHI >5/h were male sex, age, sedentary lifestyle, OSA severity, cardiovascular co‐morbidities (heart failure and arrhythmia) and type of interface (orofacial mask versus nasal mask: OR = 2.15 (95%CI: 1.95; 2.37)). A subgroup analysis found that patients using pressures above 10 cm H2O were 1.43 (95% CI: 1.3; 1.57) times more likely to have residual AHI > 5/h. Conclusion Knowing about risk factors for residual apnoeic–hypopnoeic events may assist in the timely provision of personalized care including the type of PAP therapy, attention to co‐morbidities and choice of interface.

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Incorporating polysomnography into obstructive sleep apnoea phenotyping: moving towards personalised medicine for OSA

Cited by 23 publications

References 20 publications

Obstructive sleep apnea and comorbidities: a dangerous liaison

Obstructive sleep apnea and comorbidities: a dangerous liaison

Self-reported sleepiness and not the apnoea hypopnoea index is the best predictor of sleepiness-related accidents in obstructive sleep apnoea

Partial failure of CPAP treatment for sleep apnoea: Analysis of the French national sleep database

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