Association between polysomnographic categories and clinical profile in patients with obstructive sleep apneas (OSA)

Abstract

Obstructive sleep apnea (OSA) is a heterogeneous condition associated with cardiometabolic disease, characterized by recurrent upper airway collapse during sleep. It is classified as mild-moderate-severe with the apnea-hypopnea/hour of sleep index (AHI), which does not capture its severity in all its magnitude. Intermittent hypoxemia (IH) and sleep fragmentation (SF) are not usually considered to classify OSA. Objectives: 1) To analyze the association between polysomnographic categories (PC)  and clinical profile in patients with OSA. 2) To describe the clinical characteristics and cardiometabolic morbidity profile according to their PC.

Prospective, observational, analytical, cross-sectional study. Patients over 18 years of age with moderate and severe OSA (AHI≥15/hour) without treatment were included. IMER Institute: 2019-2021. Patients with respiratory insufficiency, insomnia, sleep deprivation, problematic substance use (cannabis, cocaine, others), CNS stimulant-depressant medication were excluded. Polysomnographic data were acquired and interpreted using validated equipment and standard guidelines. Four PCs were defined: high HI PC, non-high HI PC, SF present PC, and SF absent PC. Surrogates: desaturations/hour, oxygen saturation (SaO2) <90%, mean SaO2, nadir SaO2, arousals/hour. The clinical profile included demographics, tobacco/alcohol use, symptomatology (snoring, excessive daytime sleepiness, breathing pauses, non-restorative sleep, fatigue, gasping), physical examination, cardiometabolic consequences, comorbidities, and quality of life (Quebec). Statistics: Continuous variables: center-dispersion measures. Categorical variables: absolute-percentage distributions. Comparison of means: Student test or Kruskal Wallis, comparison between categorical variables: chi-square. Significance level p=≤0.05. Continuous variables: Pearson. Project approved by IEC.

n=44, 59.1% male, age: 58.6 (25-76) years. High HI PC was associated with male sex, alcohol consumption, daytime sleepiness, non-restorative sleep, shortness of breath, larger neck and waist circumference, high blood pressure, overweight/obesity, COPD, metabolic syndrome, heart failure and impaired quality of life (p≤0.05). FS present PC was associated with higher heart rate and hypothyroidism (p≤0.05).

High HI PC and surrogates were associated with male sex, alcohol consumption, sleepiness, unrefreshing sleep, shortness of breath, neck and waist circumference, HBP, overweight/obesity, COPD, metabolic syndrome, and heart failure. Present FS PC and surrogates were associated with higher heart rate and hypothyroidism.