Percentage of sleep time with increase in respiratory effort is a strong predictor of prevalent hypertension in obstructive sleep apnea patients

Abstract

<b>Rationale:</b> Increase in respiratory effort (RE) is a key feature of obstructive sleep apnea (OSA) and is participating in sympathetic overactivity and remodeling of vascular walls. We aimed to evaluate the impact of percentage of sleep time&nbsp;in RE (RE_dt) as a predictor of prevalent hypertension (HT) in adults with OSA. <b>Methods:</b> A machine learning model was built to predict HT from clinical profiles including age, sex, BMI, conventional PSG indices and RE_dt derived from mandibular movement signals (Sunrise, Namur, Belgium). <b>Results:</b> In 1126 patients referred for suspected OSA (M/F ratio = 1.2; BMI = 31.4 ± 7.6; apnea hypopnea index (AHI) = 24.6 ± 20.9), HT prevalence was 30.8%. Percentage of TST spent in RE was significantly associated with a higher likelihood of prevalent HT (OR = 17.6; 95%CI: 9.7-31.9). The classification rule allows for predicting HT with high accuracy (85.9%). Shapley additive explanation process was conducted to assign a score to each feature values depending on their contribution to the prediction. This analysis (Figure) revealed that RE_dt was the best predictor among sleep test driven metrics, its contribution was even better than that of ODI, AHI or RDI. <b>Conclusion:</b> The percentage of sleep time spent with an increase in RE derived from mandibular movement signals appears as a new relevant metric to assess OSA impact in cardiovascular risk.