Obstructive sleep apnea subtypes by cluster analysis

Abstract

A sample of 84 adult male patients with obstructive sleep apnea (OSA) were classified by a cluster analysis on the basis of apnea index (AI) and body mass index (BMI). Demographic, cephalometric, tongue, soft palate, and upper airway-size data were evaluated for the two subgroups of OSA patients and for 18 control subjects. One OSA group consisted of 43 patients with a high AI and low BMI ratio, the other group was comprised of 41 patients with a low AI and high BMI ratio. The patients with a high AI and low BMI ratio had retruded mandibles with high mandibular plane angles and proclined lower incisors. The patients with a low AI and high BMI ratio had inferior hyoid bones and large soft palates. A multiple regression analysis was performed between AI (the dependent variable) and the other variables (independent variables) for each of the subgroups. In the patients with a high AI and low BMI ratio, a high AI was related to a large skeletal anteroposterior discrepancy, a steep mandibular plane, and an inferoanterior position of the hyoid bone. In the patients with a low AI and high BMI ratio, a high AI was related to a large tongue and a small upper airway. In both groups, BMI was the major contributor to AI. In conclusion, these two groups may represent distinct subgroups of OSA patients and provide some insight into the contribution of obesity to the pathogenesis of OSA. The patients with a high AI and low BMI ratio have a skeletal mismatch, whereas the patients with a low AI and high BMI have atypical soft tissue structures.