0459 GENERALIZABLE OSA CLINICAL SUBGROUPS IN AN INTERNATIONAL SLEEP CENTER POPULATION

Abstract

A recent study of moderate-severe obstructive sleep apnea (OSA) in Iceland identified 3 disease subgroups related to clinical symptoms and comorbidities. Using an international sample of OSA patients, we sought to replicate this original result and examine whether the subgroups are generalizable to an ethnically diverse sample of patients. Using data from 988 moderate-severe OSA patients (apnea-hypopnea index [AHI] ≥15 events/hour) recruited as part of the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease and diabetes mellitus. The original three OSA subgroups of minimally symptomatic, disturbed sleep and excessively sleepy patients replicated within 215 SAGIC patients recruited from Iceland, independent from the Icelandic sample used in the original clustering analysis, as well as in the remaining 773 patients recruited from 5 other countries. We observed no differences in AHI among the 3 subgroups in either Iceland (p=0.781) or the international sample (p=0.872); thus, these clinical subgroups are not driven by OSA severity. Differences in age, gender or BMI among the 3 subgroups were generally small. Within the larger international sample, the three subgroups originally found in Iceland were extended to six optimal subgroups: 3 related to the combination of severe excessive sleepiness symptoms, disturbed sleep or both, 2 subgroups of less symptomatic patients with either moderate sleepiness or witness OSA events, and a relatively asymptomatic group. Among these subgroups, we observed significant differences in age, gender, BMI and ethnicity, as well AHI, although all subgroups were still middle-aged, obese and had severe disease on average. These results both confirm and extend previously identified clinical subgroups of OSA with respect to symptoms and comorbidities. Leveraging these subgroups to move beyond a uniform approach to disease management and into more personalized care is an important future endeavor in Sleep Medicine.