CHEST Guidelines-Symptom-Subtypes-in-OSA

Symptom-Subtypes-in-OSA_chest

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Obstructive Sleep Apnea (OSA) is a prevalent condition characterized by diverse symptoms and associated with various health risks, especially cardiovascular issues. The heterogeneity in symptoms among those with the same severity of OSA has led researchers to use cluster analysis to identify subtypes of patients who share similar symptom characteristics. This approach aims to improve personalized clinical management as well as treatment strategies.<br /><br />In seminal research with the Icelandic Sleep Apnea Cohort (ISAC), three primary subtypes of OSA were identified: disturbed sleep (characterized by insomnia), excessively sleepy (high sleepiness scores), and minimally symptomatic. These findings have been corroborated in various global studies and diverse populations, including the Sleep Apnea Global Interdisciplinary Consortium (SAGIC) and community-based cohorts like the Sleep Heart Health Study (SHHS).<br /><br />A recent study by Labarca et al. has validated these subtypes within the Hispanic population in Chile, emphasizing the reproducibility of the ISAC and SHHS-derived subtypes. Importantly, they found that those in the excessively sleepy subtype faced higher cardiovascular mortality risk, a finding aligned with previous SHHS outcomes. This subtype may thus be a critical marker for heightened cardiovascular risk in OSA patients, highlighting a potential need for targeted therapeutic interventions.<br /><br />The article underscores the need for future research to elucidate why the excessively sleepy subtype is at greater cardiovascular risk. This may include investigating the physiological and molecular mechanisms that separate this subtype from others, given that excessive sleepiness alone does not necessarily correlate with increased cardiovascular events in the absence of OSA.<br /><br />Finally, developing an efficient method for identifying these subtypes in clinical practice is vital, as demonstrated in chronic obstructive pulmonary disease (COPD) phenotyping, to further support personalized treatment strategies tailored to individual patient needs.

Keywords

Obstructive Sleep Apnea

cardiovascular risks

cluster analysis

personalized treatment

Icelandic Sleep Apnea Cohort

Sleep Heart Health Study

excessively sleepy subtype

Hispanic population

cardiovascular mortality

therapeutic interventions