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Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients
Open accessAbstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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“In contrast, the disturbed sleep or “insomnia” subtype, a predominant cluster in a survey of ESADA, was more frequently linked with cardiovascular comorbidity than the sleepy phenotype, despite lower mean AHI values (Saaresranta et al., 2016).”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Saaresranta et al., 2016
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“reliance on this single profile clearly does not represent all OSA sufferers [26,27,28].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [26]
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Self-citationThe different clinical faces of obstructive sleep apnoea: a cluster analysis
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Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up
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Self-citationDisorders of glucose metabolism in sleep apnea
Punjabi, N. M., & Polotsky, V. Y. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00695.2005 · Cited by 381
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Metrics of sleep apnea severity: beyond the apnea-hypopnea index
Malhotra, A., Ayappa, I., Ayas, N., Collop, N., Kirsch, D., Mcardle, N., Mehra, R., Pack, A. I., Punjabi, N., White, D. P., et al. (2021) · SLEEP · doi:10.1093/sleep/zsab030 · Cited by 489
Sex differences in obstructive sleep apnoea
Bonsignore, M. R., Saaresranta, T., & Riha, R. L. (2019) · European Respiratory Review · doi:10.1183/16000617.0030-2019 · Cited by 367
Self-citationSleep and Sleep Disorders in the Menopausal Transition
Baker, F. C., Lampio, L., Saaresranta, T., & Polo‐Kantola, P. (2018) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2018.04.011 · Cited by 321
Self-citationSweetman, A., Lack, L., & Bastien, C. (2019) · Brain Sciences · doi:10.3390/brainsci9120371 · Cited by 253
“Between 2013 and 2018, a number of large cluster analyses of OSA samples also identified that 32%–54% of OSA patients indicate symptoms of ‘disturbed sleep’, characterized by nocturnal insomnia symptoms, more frequent use of sedative-hypnotic medications, and lower use of CPAP therapy [26,27,41,42].”
BackgroundRanderath, W., Bassetti, C. L., Bonsignore, M. R., Farre, R., Ferini-Strambi, L., Grote, L., Hedner, J., Kohler, M., Martinez-Garcia, M.-A., Mihaicuta, S., et al. (2018) · European Respiratory Journal · doi:10.1183/13993003.02616-2017 · Cited by 245
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Metadata
- Authors
- Saaresranta, T., Hedner, J., Bonsignore, M. R., Riha, R. L., McNicholas, W. T., Penzel, T., Anttalainen, U., Kvamme, J. A., Pretl, M., Sliwinski, P., Verbraecken, J., Grote, L., & ESADA Study Group
- Affiliations
- University of Turku (FI)
- Sahlgrenska University Hospital (SE)
- Istituto di Biomedicina e di Immunologia Molecolare Alberto Monroy (IT)
- Edinburgh Royal Infirmary (GB)
- University College Dublin (IE)
- International Clinical Research Center, St. Anne's University Hospital Brno (CZ)
- Helse Førde (NO)
- Charles University (CZ)
- University of Antwerp (BE)
- Corresponding author
- Saaresranta, Tarja
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-10-04
- Volume
- 11
- Issue
- 10
- Pages
- e0163439
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5049787
- OpenAlex
- W2529555766
- Cited by
- 154
- References
- 45
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 16 · 2023: 11 · 2022: 13 · 2021: 20 · 2020: 19 · 2019: 20 · 2018: 24 · 2017: 10
- FWCI
- 14.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repositori ObertUDL (University of Lleida) (publishedVersion, other-oa)
- UTUPub (University of Turku) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, other-oa)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, cc-by)
- Funders
- European Respiratory Society
- Sleep Research Society
- ResMed
- Ege Üniversitesi
- Università degli Studi di Palermo
- Turun Yliopisto
- Sahlgrenska Universitetssjukhuset
- Universiteit Antwerpen
- Filha
- Turun Yliopistollinen Keskussairaala
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- obstructive sleep apnea, clinical phenotype, comorbidities, excessive daytime sleepiness, insomnia, cardiovascular comorbidity, psychiatric comorbidity, CPAP adherence, apnea-hypopnea index, European patients
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Phenotype, Prospective Studies, Risk Factors, Sleep Apnea Syndromes, Comorbidity, Prevalence, White People, Young Adult
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