Changing Faces of OSA: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort.

Changing Faces of OSA: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort.

Sleep. 2018 Jan 02;:

Authors: Pien GW, Ye L, Keenan BT, Maislin G, Björnsdóttir E, Arnardottir ES, Benediktsdottir B, Gislason T, Pack AI

Abstract
Study Objectives: Distinct clinical phenotypes of obstructive sleep apnea (OSA) have been identified: Disturbed Sleep, Minimally Symptomatic, and Sleepy. Determining whether these phenotypes respond differently to standard treatment helps create a foundation for personalized therapies. We compared responses to positive airway pressure (PAP) therapy in these clinical OSA phenotypes.
Methods: The study sample included 706 patients from the Icelandic Sleep Apnea Cohort with moderate-to-severe OSA who were prescribed PAP. Linear and logistic mixed models were used to compare two-year changes in demographics, comorbid diseases, and sleep-related health issues within and across OSA clinical phenotypes. Relationships between changes in symptoms and PAP adherence were also examined.
Results: Overall, effect sizes were moderate to large when comparing sleepiness, insomnia-related, and apneic symptom changes in the Sleepy group to changes in other 2 groups, especially those in the Minimally Symptomatic group. Within the Disturbed Sleep group, PAP users and non-users demonstrated similar changes in insomnia-related symptoms. The Minimally Symptomatic group remained relatively asymptomatic, but reported significant decreases in daytime sleepiness and physical fatigue; PAP users generally had larger improvements. The Sleepy group had reductions in nearly all measured symptoms, including large reductions in drowsy driving; almost all of these improvements were greater among PAP users than non-users.
Conclusions: OSA treatment response patterns differed by initial clinical phenotype and PAP adherence. Individuals with insomnia-related symptoms may require additional targeted therapy for these complaints. These findings underscore the need for a personalized approach to management that recognizes patients with a range of OSA presentations.

PMID: 29301021 [PubMed - as supplied by publisher]

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