Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients

• Published in: PloS one Vol. 11; no. 10; p. e0163439
• Main Authors: Saaresranta, Tarja, Hedner, Jan, Bonsignore, Maria R, Riha, Renata L, McNicholas, Walter T, Penzel, Thomas, Anttalainen, Ulla, Kvamme, John Arthur, Pretl, Martin, Sliwinski, Pawel, Verbraecken, Johan, Grote, Ludger
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04-10-2016; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Apnea; Biology and Life Sciences; Body mass; Body mass index; Body size; Cardiovascular disease; Care and treatment; Clinical Medicine; Cluster analysis; cohort; common; Comorbidity; Continuous positive airway pressure; Daytime; depression; European Continental Ancestry Group; Female; Follow-Up Studies; Genetic aspects; Humans; hypertension; Insomnia; insomnia symptoms; Klinisk medicin; Male; Medicine and Health Sciences; Middle Aged; Night; Nighttime; Patients; Phenotype; Phenotypes; positive airway pressure; Prevalence; Prospective Studies; Respiratory tract; Risk Factors; Science & Technology; Sleep; Sleep and wakefulness; Sleep apnea; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - epidemiology; Sleep disorders; Sleepiness; therapy; women; Young Adult; Czech Republic; Sweden; Belgium; United Kingdom > UK; Ireland; Finland; Italy; Scotland; Edinburgh Scotland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0163439

Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established.
A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/non-insomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype.
The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188-1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity.
Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS.