Clinical phenotypes of obstructive sleep apnea identified using cluster analysis.

OBJECTIVE

To describe clinical obstructive sleep apnea (OSA) phenotypes based on emerging groups.

METHODS

A cross-sectional study was conducted among adult patients referred for home sleep respiratory assessment. Cluster analysis was conducted based on sex, age, Epworth Sleepiness Scale (ESS) score, BMI, neck > 40 cm (women) or > 42 cm (men), hypertension, and time spent with SpO2 below 90% (T<90%).

RESULTS

The K-means algorithm identified three groups: 1) Severe obesity, borderline sleepiness (n = 1,026) with a mean BMI of 34.7 kg/m2, ESS score of 9.3, apnea-hypopnea index (AHI) of 31.3 events/h, and T<90% of 4.9 (%); 2) Moderate disease burden, asymptomatic without hypoxemia (n = 497) with a mean BMI = 28.5 kg/m2, ESS score = 6.6, AHI = 25.7 events/h, and T<90% of 1.8%; and 3) Sleepy patients with severe OSA (n = 993) with a mean BMI = 29.5 kg/m2, ESS score = 13.6, AHI = 33.9 events/h, and T<90% of 3.6%.

CONCLUSIONS

In this large sample of Latin American patients with OSA diagnosed using home respiratory polygraphy, cluster analysis identified three clinically relevant phenotypes. Notably, severe OSA was observed both in patients with severe obesity and borderline daytime symptoms and in overweight patients with excessive daytime sleepiness. These findings highlight the heterogeneity of OSA and emphasize the need for individualized phenotype-based clinical approaches.