Chapter 130 - Clinical and Physiologic Heterogeneity of Obstructive Sleep Apnea

Abstract

Heterogeneity in the physiologic factors and range of clinical presentations contributing to the development of obstructive sleep apnea (OSA) is increasingly recognized. Investigators have sought to distinguish subtypes or phenotypes of OSA based on characteristic pathophysiologic or clinical attributes. Anatomic and physiologic subtypes have been used to identify individuals likely to have OSA and to determine whether particular subgroups respond better to some therapies than others, especially based on underlying pathophysiology and mechanism of treatment. A range of clinical OSA phenotypes have been differentiated by traits including age, sex, and presenting symptoms. Recent studies using unsupervised approaches, such as cluster analysis, have expanded our understanding of clinical phenotypes in OSA, differences in how they respond to therapy, and relationships to outcomes, such as cardiovascular disease. This chapter reviews anatomic and physiologically focused and clinically oriented OSA phenotypes and explores their implications for pathogenesis, treatment, and clinical outcomes.