Obstructive Sleep Apnea With or Without Excessive Daytime Sleepiness: Clinical and Experimental Data-Driven Phenotyping

Abstract

Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common—but not universal—accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients.Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed.Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas.Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment.The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient's specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA.

Automatic Derivation of Continuous Positive Airway Pressure Settings: Comparison with In-Laboratory Titration

“…16 Eliminating sleep fragmentation using hypoxemia is important for improving daytime sleepiness and achieving good clinical outcomes in CPAP therapy. 17 Considering the occurrence arousal during nighttime sleep is a significant clinical factor for determining the pressure prescribed for achieving successful and effective CPAP therapy in patients with OSA. Care is therefore needed when selecting APAP titration without consideration of arousal during sleep in OSA patients who have frequent arousal events.…”

A review of approaches for analysing obstructive sleep apnoea‐related patterns in pulse oximetry data

“…This discussion has focused on long‐term mortality and cardiovascular outcomes, but identifying oximetry‐based predictors of short‐term outcomes such as sleepiness or cognitive function would also be of considerable interest and utility …”

Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients

“…Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders, affecting at least 20% of the adult population in Western countries [2][3][4]. OSA is attributed to daytime symptoms of shortened daytime sleep latencies as well as chronic fatigue and sleepiness [5][6][7]. Furthermore, OSA is related to poor neurocognitive performance and inability to sustain attention [8][9][10].…”