European journal of internal medicine · 2026
Respiratory-hypoxic burden and multimorbidity-related vulnerability are distinct dimensions of obstructive sleep apnea: A retrospective cohort analysis.
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Gironda Giada, Sartori Giulia, Fantin Alberto, Castaldo Nadia, Crisafulli Ernesto
Аннотация
BACKGROUND: Obstructive sleep apnea (OSA) is a heterogeneous disorder in which conventional apnea-hypopnea index (AHI)-based severity classification incompletely captures respiratory burden, nocturnal hypoxemia, obesity, and multimorbidity. Whether OSA severity is organized along distinct respiratory and multimorbidity-related dimensions remains unclear.
OBJECTIVES: To determine whether OSA severity is organized along distinct respiratory-hypoxic and multimorbidity-related dimensions and whether these dimensions define clinically meaningful patient phenotypes.
METHODS: We retrospectively analyzed prospectively collected data from 306 untreated adults with OSA. Demographic, anthropometric, respiratory polygraphy, oximetry, daytime sleepiness, and Cumulative Illness Rating Scale (CIRS)-derived measures were assessed. Principal component analysis (PCA) identified latent severity dimensions, followed by hierarchical and k-means clustering to derive clinical phenotypes.
RESULTS: PCA identified two partially dissociated dimensions explaining 57.4% of total variance: a respiratory-hypoxic burden dimension characterized by AHI, nocturnal hypoxemia, and obesity, and an age- and multimorbidity-related vulnerability dimension characterized by age and CIRS-derived measures. Four clinically distinct phenotypes emerged: older-multimorbid (n = 101), hypoxic-metabolic (n = 65), young-preserved (n = 92), and severe obese-hypoxic (n = 48). Multimorbidity-related vulnerability showed only weak correlations with conventional respiratory severity metrics.
CONCLUSION: OSA severity appears to be organized along complementary respiratory-hypoxic and multimorbidity-related dimensions. This multidimensional framework provides a clinically interpretable approach to understanding patient heterogeneity beyond conventional respiratory severity metrics.
OBJECTIVES: To determine whether OSA severity is organized along distinct respiratory-hypoxic and multimorbidity-related dimensions and whether these dimensions define clinically meaningful patient phenotypes.
METHODS: We retrospectively analyzed prospectively collected data from 306 untreated adults with OSA. Demographic, anthropometric, respiratory polygraphy, oximetry, daytime sleepiness, and Cumulative Illness Rating Scale (CIRS)-derived measures were assessed. Principal component analysis (PCA) identified latent severity dimensions, followed by hierarchical and k-means clustering to derive clinical phenotypes.
RESULTS: PCA identified two partially dissociated dimensions explaining 57.4% of total variance: a respiratory-hypoxic burden dimension characterized by AHI, nocturnal hypoxemia, and obesity, and an age- and multimorbidity-related vulnerability dimension characterized by age and CIRS-derived measures. Four clinically distinct phenotypes emerged: older-multimorbid (n = 101), hypoxic-metabolic (n = 65), young-preserved (n = 92), and severe obese-hypoxic (n = 48). Multimorbidity-related vulnerability showed only weak correlations with conventional respiratory severity metrics.
CONCLUSION: OSA severity appears to be organized along complementary respiratory-hypoxic and multimorbidity-related dimensions. This multidimensional framework provides a clinically interpretable approach to understanding patient heterogeneity beyond conventional respiratory severity metrics.