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CC BY-NC-ND 4.0 · Sleep Sci 2023; 16(04): e446-e453
DOI: 10.1055/s-0043-1776770
Original Article

Clinical Application of the Multicomponent Grading System for Sleep Apnea Classification and Incident Cardiovascular Mortality

Jorge Jorquera
1   Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
,
Jorge Dreyse
1   Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
,
Constanza Salas
1   Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
,
Francisca Letelier
1   Center for Respiratory Diseases, Las Condes Clinic, Faculty of Medicine, Finis Terrae University, Santiago, Chile
,
Bunio Weissglas
2   Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
,
Javiera Del-Río
2   Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
,
Mario Henríquez-Beltrán 
3   Núcleo de Investigación en Ciencias de la Salud, Universidad Adventista de Chile, Chillán, Chile
4   Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomas, Chile
5   Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
,
Gonzalo Labarca 
2   Department of Clinical Biochemistry and Immunology, Facultad de Farmacia, Universidad de Concepción, Bío-Bío, Chile
4   Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomas, Chile
,
Jorge Jorquera-Díaz
5   Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
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Abstract

Objective To evaluate the clinical utility of the Baveno classification in predicting incident cardiovascular mortality after five years of follow-up in a clinic-based cohort of patients with obstructive sleep apnea (OSA).

Materials and Methods We evaluated the reproducibility of the Baveno classification using data from the Santiago Obstructive Sleep Apnea (SantOSA) study. The groups were labeled Baveno A (minor symptoms and comorbidities), B (severe symptoms and minor comorbidities), C (minor symptoms and severe comorbidities), and D (severe symptoms and comorbidities). Within-group comparisons were performed using analysis of variance (ANOVA) and post hoc tests. The associations between groups and incident cardiovascular mortality were determined through the Mantel-Cox and Cox proportional hazard ratios (HRs) adjusted by covariables.

Results A total of 1,300 OSA patients were included (Baveno A: 27.7%; B: 28%; C: 16.8%; and D: 27.5%). The follow-up was of 5.4 years. Compared to Baveno A, the fully-adjusted risk of cardiovascular mortality with Baveno B presented an HR of 1.38 (95% confidence interval [95%CI]: 0.14–13.5; p = 0.78); with Baveno C, it was of 1.71 (95%CI: 0.18–16.2; p = 0.63); and, with Baveno D, of 1.04 (95%CI: 0.12–9.2; p = 0.98). We found no interactions involving Baveno group, sex and OSA severity.

Discussion Among OSA patients, the Baveno classification can describe different subgroups. However, its utility in identifying incident cardiovascular mortality is unclear. Long-term follow-up studies and the inclusion of demographic variables in the classification could improve its ability to detect a high-risk phenotype associated with cardiovascular mortality.

Conclusion The Baveno classification serves as a valuable method for categorizing varying groups of patients afflicted with OSA. Nevertheless, its precision in identifying occurrence of cardiovascular mortality is still unclear.

Keywords

obstructive sleep apnea - cardiovascular - hypoxia - latino - precision medicine

Supplementary Material



Publication History

Received: 14 July 2022

Accepted: 14 February 2023

Article published online:
22 November 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Zinchuk A, Yaggi HK. Phenotypic Subtypes of OSA: A Challenge and Opportunity for Precision Medicine. Chest 2020; 157 (02) 403-420
    CrossrefPubMedGoogle Scholar
  • 2 Malhotra A, White DP. Obstructive sleep apnoea. Lancet 2002; 360 (9328): 237-245
    CrossrefPubMedGoogle Scholar
  • 3 Veasey SC, Rosen IM. Obstructive Sleep Apnea in Adults. N Engl J Med 2019; 380 (15) 1442-1449
    CrossrefPubMedGoogle Scholar
  • 4 Labarca G, Dreyse J, Drake L, Jorquera J, Barbe F. Efficacy of continuous positive airway pressure (CPAP) in the prevention of cardiovascular events in patients with obstructive sleep apnea: Systematic review and meta-analysis. Sleep Med Rev 2020; 52: 101312
    CrossrefPubMedGoogle Scholar
  • 5 Dodds S, Williams LJ, Roguski A. et al. Mortality and morbidity in obstructive sleep apnoea-hypopnoea syndrome: results from a 30-year prospective cohort study. ERJ Open Res 2020; 6 (03) 00057-02020
    CrossrefPubMedGoogle Scholar
  • 6 Javaheri S, Martinez-Garcia MA, Campos-Rodriguez F, Muriel A, Peker Y. Continuous Positive Airway Pressure Adherence for Prevention of Major Adverse Cerebrovascular and Cardiovascular Events in Obstructive Sleep Apnea. Am J Respir Crit Care Med 2020; 201 (05) 607-610
    CrossrefPubMedGoogle Scholar
  • 7 Javaheri S, Martinez-Garcia MA, Campos-Rodriguez F. CPAP Treatment and Cardiovascular Prevention: We Need to Change the Design and Implementation of Our Trials. Chest 2019; 156 (03) 431-437
    CrossrefPubMedGoogle Scholar
  • 8 Edwards BA, Redline S, Sands SA, Owens RL. More than the sum of the respiratory events: personalized medicine approaches for obstructive sleep apnea. Am J Respir Crit Care Med 2019; 200 (06) 691-703
    CrossrefPubMedGoogle Scholar
  • 9 Qaseem A, Dallas P, Owens DK, Starkey M, Holty JE, Shekelle P. Clinical Guidelines Committee of the American College of Physicians. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from theAmerican College of Physicians. Ann Intern Med 2014; 161 (03) 210-220 DOI: 10.7326/M12-3187.
    CrossrefPubMedGoogle Scholar
  • 10 Kapur VK, Auckley DH, Chowdhuri S. et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2017; 13 (03) 479-504 DOI: 10.5664/jcsm.6506.
    CrossrefPubMedGoogle Scholar
  • 11 Mazzotti DR, Keenan BT, Lim DC, Gottlieb DJ, Kim J, Pack AI. Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes. Am J Respir Crit Care Med 2019; 200 (04) 493-506
    CrossrefPubMedGoogle Scholar
  • 12 Kim J, Keenan BT, Lim DC, Lee SK, Pack AI, Shin C. Symptom-Based Subgroups of Koreans With Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14 (03) 437-443
    CrossrefPubMedGoogle Scholar
  • 13 Keenan BT, Kim J, Singh B. et al. Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis. Sleep 2018; 41 (03) zsx214
    CrossrefPubMedGoogle Scholar
  • 14 Quan W, Zheng D, Douglas McEvoy R. et al; SAVE Investigators. High Risk Characteristics for Recurrent Cardiovascular Events among Patients with Obstructive Sleep Apnoea in the SAVE Study. EClinicalMedicine 2018; 2-3: 59-65
    CrossrefPubMedGoogle Scholar
  • 15 Gagnadoux F, Le Vaillant M, Paris A. et al; Institut de Recherche en Santé Respiratoire des Pays de la Loire Sleep Cohort Group. Relationship Between OSA Clinical Phenotypes and CPAP Treatment Outcomes. Chest 2016; 149 (01) 288-290
    CrossrefPubMedGoogle Scholar
  • 16 Azarbarzin A, Sands SA, Younes M. et al. The Sleep Apnea-Specific Pulse-Rate Response Predicts Cardiovascular Morbidity and Mortality. Am J Respir Crit Care Med 2021; 203 (12) 1546-1555 DOI: 10.1164/rccm.202010-3900OC.
    CrossrefPubMedGoogle Scholar
  • 17 Azarbarzin A, Sands SA, Stone KL. et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J 2019; 40 (14) 1149-1157
    CrossrefPubMedGoogle Scholar
  • 18 Randerath W, Bassetti CL, Bonsignore MR. et al. Challenges and perspectives in obstructive sleep apnoea: Report by an ad hoc working group of the Sleep Disordered Breathing Group of the European Respiratory Society and the European Sleep Research Society. Eur Respir J 2018; 52 (03) 1702616
    CrossrefPubMedGoogle Scholar
  • 19 McNicholas WT, Bassetti CL, Ferini-Strambi L. et al; Baveno Working Group members. Challenges in obstructive sleep apnoea. Lancet Respir Med 2018; 6 (03) 170-172
    CrossrefPubMedGoogle Scholar
  • 20 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007; 4 (10) e296 DOI: 10.1371/journal.pmed.0040296.
    CrossrefPubMedGoogle Scholar
  • 21 Labarca G, Dreyse J, Salas C. et al. A clinic-based cluster analysis in patients with moderate-severe obstructive sleep apnea (OSA) in Chile. Sleep Med 2020; 73: 16-22 DOI: 10.1016/j.sleep.2020.04.001.
    CrossrefPubMedGoogle Scholar
  • 22 Labarca G, Dreyse J, Salas C, Letelier F, Jorquera J. A Validation Study of Four Different Cluster Analyses of OSA and the Incidence of Cardiovascular Mortality in a Hispanic Population. Chest 2021; 160 (06) 2266-2274 DOI: 10.1016/j.chest.2021.06.047. [Internet]
    CrossrefPubMedGoogle Scholar
  • 23 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (06) 540-545
    CrossrefPubMedGoogle Scholar
  • 24 Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med 2002; 347 (07) 498-504 DOI: 10.1056/NEJMcp012849.
    CrossrefPubMedGoogle Scholar
  • 25 Labarca G, Dreyse J, Salas C, Gaete MI, Jorquera J. Performance of instruments aimed at detecting obstructive sleep apnea syndrome among individuals in Chile. J Bras Pneumol 2019; 46 (01) e20190015 DOI: 10.1590/1806-3713/e20190015.
    CrossrefPubMedGoogle Scholar
  • 26 Ng SS, Chan TO, To KW. et al. Validation of Embletta portable diagnostic system for identifying patients with suspected obstructive sleep apnoea syndrome (OSAS). Respirology 2010; 15 (02) 336-342
    CrossrefPubMedGoogle Scholar
  • 27 Labarca G, Dreyse J, Salas C. et al. Differences between manual and automatic analysis in determining the severity of obstructive sleep apnea using home sleep apnea testing. Sleep Med 2018; 47: 66-71 DOI: 10.1016/j.sleep.2018.03.015.
    CrossrefPubMedGoogle Scholar
  • 28 Randerath WJ, Herkenrath S, Treml M. et al. Evaluation of a multicomponent grading system for obstructive sleep apnoea: the Baveno classification. ERJ Open Res 2021; 7 (01) 00928-02020
    CrossrefPubMedGoogle Scholar
  • 29 Bakris G, Ali W, Parati G. ACC/AHA Versus ESC/ESH on Hypertension Guidelines: JACC Guideline Comparison. J Am Coll Cardiol 2019; 73 (23) 3018-3026
    CrossrefPubMedGoogle Scholar
  • 30 Martinez-Garcia MA, Campos-Rodriguez F, Barbé F, Gozal D, Agustí A. Precision medicine in obstructive sleep apnoea. Lancet Respir Med 2019; 7 (05) 456-464
    CrossrefPubMedGoogle Scholar
  • 31 Andrus B, Lacaille D. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. J Am Coll Cardiol 2014; 63 (25 Pt A): 2886
    CrossrefPubMedGoogle Scholar
  • 32 Labarca G, Gower J, Lamperti L, Dreyse J, Jorquera J. Chronic intermittent hypoxia in obstructive sleep apnea: a narrative review from pathophysiological pathways to a precision clinical approach. Sleep Breath 2020; 24 (02) 751-760
    CrossrefPubMedGoogle Scholar
  • 33 Labarca G, Campos J, Thibaut K, Dreyse J, Jorquera J. Do T90 and SaO2 nadir identify a different phenotype in obstructive sleep apnea?. Sleep Breath 2019; 23 (03) 1007-1010
    CrossrefPubMedGoogle Scholar
  • 34 Labarca G, Jorquera J, Dreyse J. et al. Hypoxemic features of obstructive sleep apnea and the risk of mortality: a cluster analysis. Sleep Breath 2020; ••• DOI: 10.1007/s11325-020-02064-7.
    CrossrefPubMedGoogle Scholar
  • 35 Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365 (9464): 1046-1053
    CrossrefPubMedGoogle Scholar
  • 36 Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunström E. Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Nonsleepy Obstructive Sleep Apnea. The RICCADSA Randomized Controlled Trial. Am J Respir Crit Care Med 2016; 194 (05) 613-620
    CrossrefPubMedGoogle Scholar
  • 37 McEvoy RD, Antic NA, Heeley E. et al; SAVE Investigators and Coordinators. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. N Engl J Med 2016; 375 (10) 919-931
    CrossrefPubMedGoogle Scholar
  • 38 Sánchez-de-la-Torre M, Sánchez-de-la-Torre A, Bertran S. et al; Spanish Sleep Network. Effect of obstructive sleep apnoea and its treatment with continuous positive airway pressure on the prevalence of cardiovascular events in patients with acute coronary syndrome (ISAACC study): a randomised controlled trial. Lancet Respir Med 2020; 8 (04) 359-367
    CrossrefPubMedGoogle Scholar