Bezdech senny
Rokowania, prognozy i postęp choroby

Obturacyjny bezdech senny (OBS) dotyka około 4% mężczyzn i 2% kobiet globalnie, stanowiąc istotny czynnik ryzyka chorób kardiometabolicznych oraz zwiększonej śmiertelności sercowo-naczyniowej, zwłaszcza przy ciężkim przebiegu (AHI ≥ 30). Terapia CPAP poprawia krótkoterminowo objawy takie jak senność dzienna i chrapanie, jednak jej wpływ na długoterminowe zapobieganie powikłaniom sercowo-naczyniowym pozostaje niepotwierdzony w randomizowanych badaniach. Wysoka heterogeniczność OBS wymaga spersonalizowanego podejścia diagnostycznego i terapeutycznego, a modele predykcyjne oparte na sztucznej inteligencji (AUC=0,976; 95% CI: 0,962-0,990) wykazują przewagę nad tradycyjnymi kwestionariuszami (SBQ, NoSAS) w identyfikacji pacjentów z umiarkowanym do ciężkim OBS. Hipoksja nocna (TST90) i częstość akcji serca są silniejszymi predyktorami zdarzeń sercowo-naczyniowych niż indeks AHI, co podkreśla potrzebę nowych narzędzi prognostycznych.

  1. Prognoza przy bezdechu sennym (Bezdech senny)
    1. Rokowanie krótkoterminowe
    2. Rokowanie długoterminowe
    3. Czynniki wpływające na prognozę
  2. Modele predykcyjne w ocenie rokowania
    1. Modele predykcyjne nasilenia OBS
    2. Modele predykcyjne powikłań sercowo-naczyniowych
    3. Dokładność modeli predykcyjnych
  3. Czynniki fizjologiczne wpływające na rokowanie
    1. Wskaźniki predykcyjne wyników sercowo-naczyniowych
    2. Wysokie wzmocnienie pętli jako czynnik patogenetyczny
  4. Personalizacja medycyny w prognozowaniu OBS
    1. Podtypy kliniczne i ich wpływ na rokowanie
    2. Indywidualizacja leczenia w oparciu o endotypy fizjologiczne
  5. Skuteczność terapii PAP
  6. Nowe perspektywy w prognozowaniu OBS
    1. Kolejne rozdziały

Prognoza przy bezdechu sennym (Bezdech senny)

Obturacyjny bezdech senny (OBS) stanowi istotny problem kliniczny i zdrowia publicznego, ponieważ przyczynia się do niekorzystnego wpływu na jakość życia, występowania objawów dziennych, wypadków drogowych oraz chorób kardiometabolicznych. 1 Zespół ten dotyka około 4% mężczyzn i 2% kobiet na całym świecie. 2 Prognoza przy bezdechu sennym zależy od wielu czynników, w tym nasilenia choroby, współistniejących schorzeń oraz stosowania się do zalecanego leczenia.

Rokowanie krótkoterminowe

Krótkoterminowa prognoza w odniesieniu do objawów takich jak senność w ciągu dnia i chrapanie waha się od dobrej do doskonałej przy regularnym stosowaniu terapii ciągłym dodatnim ciśnieniem w drogach oddechowych (CPAP). 3 Kilka badań, w tym badania kontrolowane placebo, wykazały znaczącą poprawę w zakresie funkcji poznawczych i ogólnego stanu zdrowia (np. mierzonego kwestionariuszem Medical Outcome Study Short-Form 36) po 4-8 tygodniach leczenia CPAP. 4 Należy jednak zauważyć, że badania te nie były przeprowadzane na dużej populacji ani przez okres dłuższy niż 4-8 tygodni leczenia. 5

Rokowanie długoterminowe

Długoterminowa prognoza pozostaje niejasna, ponieważ nie przeprowadzono randomizowanych badań oceniających wpływ CPAP na zapobieganie rozwojowi powikłań sercowo-naczyniowych. 6 Nieleczony ciężki OBS (AHI ≥ 30) wiąże się ze zwiększonym ryzykiem śmiertelności z przyczyn sercowo-naczyniowych, definiowanej jako zawał mięśnia sercowego (MI) lub udar mózgu zakończony zgonem. 7 U pacjentów z łagodnym OBS lub poddawanych leczeniu za pomocą CPAP nie stwierdzono istotnie zwiększonego ilorazu szans w porównaniu z grupą osób bez OBS. 8

W przypadku pacjentów z udarem mózgu, u których występuje OBS, badania wykazały, że bezdech senny wiąże się z przedłużonym pobytem w szpitalu, zwiększonym ryzykiem nawrotu udaru oraz podwyższoną śmiertelnością. 9 Istnieje pilna potrzeba opracowania trafnych narzędzi predykcyjnych do identyfikacji ryzyka OBS wśród tej szczególnie narażonej grupy pacjentów. 10

Czynniki wpływające na prognozę

Nieleczony OBS może skrócić oczekiwaną długość życia i zwiększyć ryzyko niebezpiecznych powikłań. 11 Rokowanie zależy od wielu czynników, takich jak nasilenie choroby i występowanie innych schorzeń współistniejących. 12 Można jednak oczekiwać pozytywnego wyniku, jeśli pacjent będzie przestrzegał planu leczenia, który został ustalony wspólnie z lekarzem prowadzącym. 13

W porównaniu z łagodnym OBS, pacjenci z umiarkowanym do ciężkiego OBS mają bardziej nasilone upośledzenie funkcji wszystkich narządów organizmu. 14 OBS jest niezależnym czynnikiem ryzyka rozwoju wielu chorób ogólnoustrojowych. 15

Modele predykcyjne w ocenie rokowania

Trwają intensywne prace nad opracowaniem modeli predykcyjnych, które mogłyby skuteczniej oceniać rokowanie i potencjalne powikłania u pacjentów z bezdechem sennym.

Modele predykcyjne nasilenia OBS

Model predykcyjny opracowany w jednym z badań wykazuje dobrą moc predykcyjną dla umiarkowanego do ciężkiego OBS i przewyższa inne modele predykcyjne oraz kwestionariusze. 16 Model ten charakteryzuje się dobrą zgodnością w przewidywaniu rzeczywistego występowania umiarkowanego do ciężkiego ryzyka oraz dobrą dokładnością predykcyjną. 17 Analiza decyzyjna (DCA) pokazuje, że korzyść netto z modelu nomogramu jest wyższa niż w przypadku kwestionariuszy SBQ i NoSAS, co wskazuje na dobrą użyteczność kliniczną. 18 Obszar pod krzywą (AUC) dla tego modelu predykcyjnego wynosił 0,976 (95% CI: 0,962-0,990). 19

Wraz ze wzrostem częstości występowania zespołu bezdechu sennego (OBS) na całym świecie, pojawia się potrzeba opracowania nowej metody przesiewowej, która mogłaby zrekompensować wady tradycyjnej metody diagnostycznej, jaką jest polisomnografia (PSG). 20 Badania wykazują, że metody uczenia maszynowego mają znaczny potencjał do wykorzystania w przewidywaniu ciężkości OBS. 21

Modele predykcyjne powikłań sercowo-naczyniowych

Badacze z Mount Sinai otrzymali czteroletni grant w wysokości 3 milionów dolarów z National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) na opracowanie modeli predykcyjnych opartych na sztucznej inteligencji (AI) w celu identyfikacji ryzyka zdarzeń sercowo-naczyniowych u pacjentów z obturacyjnym bezdechem sennym. 22 Amerykańskie Towarzystwo Kardiologiczne (AHA) wskazuje, że obturacyjny bezdech senny zwiększa ryzyko chorób układu sercowo-naczyniowego, w tym choroby wieńcowej, nadciśnienia tętniczego i udaru mózgu. 23

Zespół badawczy buduje narzędzia oparte na uczeniu maszynowym (ML) w celu identyfikacji pacjentów z OBS o wysokim ryzyku progresji miażdżycy i zdarzeń sercowo-naczyniowych, takich jak udar mózgu i zawał serca. 24 Dane te zostaną wykorzystane do oznaczenia kluczowych predyktorów progresji miażdżycy i zdarzeń sercowo-naczyniowych, a także do identyfikacji podgrup pacjentów opartych na ryzyku, które mają różne wyniki leczenia CPAP w odniesieniu do zdarzeń sercowo-naczyniowych. 25

Naukowcy zauważyli, że obecne narzędzia diagnostyczne dla bezdechu sennego, które zazwyczaj polegają na liczeniu zaburzeń oddychania u pacjenta podczas snu, nie są dokładnymi predyktorami krótko- i długoterminowych niekorzystnych wyników, takich jak nadmierna senność w ciągu dnia, chorobowość sercowo-naczyniowo-mózgowa i upośledzenie neuropoznawcze. 26 Modele AI są zaprojektowane w celu rozwiązania tych niedoskonałości poprzez analizę zmiennych hipoksycznych, pobudzeniowych i wentylacyjnych w celu wygenerowania spersonalizowanej oceny ryzyka pacjenta. 27

Dokładność modeli predykcyjnych

Badacze z Mount Sinai otrzymali również 4,1 miliona dolarów z National Heart, Lung, and Blood Institute (NHLBI) na opracowanie modeli sztucznej inteligencji (AI) do przewidywania niekorzystnych wyników w obturacyjnym bezdechu sennym. 28 Indeks AHI (Apnea-Hypopnea Index) ma jednak ograniczenia i niekoniecznie jest dokładnym predyktorem wyników u pacjentów, co skłania klinicystów do apelowania o opracowanie lepszych narzędzi diagnostycznych i prognostycznych. 29

Wyniki analizy ujawniły, że jeden z modeli może dokładnie przewidywać prawdopodobieństwo senności spowodowanej bezdechem z dokładnością około 87 procent, podczas gdy model wykorzystujący AHI może przewidywać ten sam parametr z dokładnością tylko 54 procent. 30 W kohorcie 4700 uczestników podejście oparte na AI mogło przewidywać śmiertelność sercowo-naczyniową z dokładnością ponad 80 procent w porównaniu do standardowego podejścia, które osiągnęło tylko 58 procent dokładności. 31

Czynniki fizjologiczne wpływające na rokowanie

Wskaźniki predykcyjne wyników sercowo-naczyniowych

Indeks bezdechów i spłyceń oddychania (AHI) nie przewidywał poważnych zdarzeń sercowo-naczyniowych (MACEs) (HR: 0,95; 95% CI 0,76 do 1,17), podczas gdy czas snu z saturacją tlenem ≤ 90% (TST90) (HR: 1,41; 95% CI 1,10 do 1,81) był niezależnym predyktorem MACEs, podobnie jak częstość akcji serca w stanie czuwania i w nocy. 32 Hipoksja związana z OBS i średnia częstość akcji serca, ale nie indeks bezdechów i spłyceń oddychania (AHI), są prawdopodobnie dominującymi predyktorami niekorzystnych wyników sercowo-naczyniowych. 33

W umiarkowanym do ciężkiego OBS (n=1108), u których wskazane było leczenie CPAP, regularne stosowanie CPAP nie było związane ze zmniejszeniem występowania MACEs. 34 Nie wszyscy pacjenci z umiarkowanym do ciężkiego OBS według kryteriów AHI odnosili jednolite korzyści z regularnej terapii CPAP, ale ci, którzy byli młodsi, z większą hipoksemią nocną, wyższym AHI i innymi współistniejącymi czynnikami ryzyka sercowo-naczyniowego, wykazywali niższą częstość występowania zdarzeń sercowo-naczyniowych przy regularnym leczeniu CPAP. 35

Wysokie wzmocnienie pętli jako czynnik patogenetyczny

Wysokie wzmocnienie pętli (niestabilna kontrola wentylacyjna) jest ważnym, ale trudnym do zmierzenia czynnikiem przyczyniającym się do patogenezy obturacyjnego bezdechu sennego (OBS), przewidującym następstwa OBS i/lub odpowiedź na leczenie. 36 Przewidywane wzmocnienie pętli wykazało umiarkowaną do wysokiej korelację z referencyjnym wzmocnieniem pętli (r=0,48; 95% CI 0,38-0,57) oraz umiarkowaną zdolność różnicowania pacjentów z wysokim i niskim wzmocnieniem pętli (pole pod krzywą=0,73; 95% CI 0,67-0,80). 37

Jest to pierwszy model predykcyjny wzmocnienia pętli oparty na łatwo dostępnych danych klinicznych, który może ułatwić retrospektywne analizy istniejących zbiorów danych, lepszy dobór pacjentów do badań klinicznych, a ostatecznie także praktykę kliniczną. 38 Ten model predykcyjny może ułatwić lepszy dobór pacjentów do badań klinicznych: pacjenci, u których przewiduje się wysokie wzmocnienie pętli, mogliby być preferencyjnie wybierani do badań interwencji obniżających wzmocnienie pętli (np. acetazolamid, tlen), ale wykluczani z interwencji ukierunkowanych na inne cechy, takie jak anatomia (np. chirurgia górnych dróg oddechowych, aparaty doustne, stymulacja nerwu podjęzykowego). 39

Personalizacja medycyny w prognozowaniu OBS

Coraz większa świadomość heterogeniczności obturacyjnego bezdechu sennego (OBS) skłania do poszukiwania bardziej spersonalizowanych metod prognostycznych i terapeutycznych. 40

Podtypy kliniczne i ich wpływ na rokowanie

Regularne leczenie CPAP nie było związane z niższym wskaźnikiem MACE, ale analiza klasterowa oparta na wyjściowych cechach klinicznych i PSG zidentyfikowała podgrupę wysokiego ryzyka, która mogła odnieść korzyści z regularnego leczenia CPAP. 41 Wyniki te dodatkowo potwierdzają, że świadomość heterogeniczności OBS umożliwiłaby lepszą identyfikację osób zagrożonych określonymi niekorzystnymi wynikami zdrowotnymi i tych, którzy najprawdopodobniej skorzystają z leczenia CPAP. 42

Określone podtypy objawów okazały się niezależnymi predyktorami występującej choroby sercowo-naczyniowej i mózgowo-naczyniowej w umiarkowanym do ciężkiego obturacyjnego bezdechu sennego, a wśród pacjentów z obturacyjnym bezdechem sennym (podtyp nadmiernie senny) stwierdzono zwiększone ryzyko wystąpienia incydentów sercowo-naczyniowych i mózgowo-naczyniowych. 43

Indywidualizacja leczenia w oparciu o endotypy fizjologiczne

Dalsza precyzacja specyficznych endotypów fizjologicznych u osób z obturacyjnym bezdechem sennym może ułatwić rozwój nowych metod leczenia, które można dostosować do indywidualnych potrzeb pacjenta, zgodnie z endotypem lub endotypami fizjologicznymi ich choroby. 44 Endotypy te mogą pomóc w identyfikacji pacjentów, u których mogą wystąpić większe poprawy objawów i bardziej wyraźne odpowiedzi na określone metody leczenia obturacyjnego bezdechu sennego. 45

Bardziej precyzyjne fenotypowanie molekularne obturacyjnego bezdechu sennego za pomocą tych i innych markerów mogłoby zapewnić bardziej zniuansowaną reprezentację choroby. 46 Ostatecznie to zaawansowane fenotypowanie mogłoby zapewnić bardziej dokładną opiekę, dopasowując precyzyjne podtypy do konkretnych metod leczenia. 47

Skuteczność terapii PAP

Terapia dodatnim ciśnieniem w drogach oddechowych (PAP) jest przepisywana pacjentom z obturacyjnym bezdechem sennym (OBS). 48 Badania kliniczne dotyczące leczenia CPAP w zakresie ochrony układu sercowo-naczyniowego były w większości negatywne. 49

Obecne badanie potwierdza stale rosnący zbiór literatury wzywającej do większego zastanowienia się i przedstawienia dowodów na poparcie definicji przestrzegania terapii PAP, która jest klinicznie znacząca. 50 Badanie nie wykazało istotnych różnic między grupami przestrzegającymi i nieprzestrzegającymi terapii PAP w zakresie śmiertelności, długości pobytu w szpitalu i liczby hospitalizacji w ośmioletnim okresie obserwacji. 51 Badanie to potwierdza ustalenia poprzednich randomizowanych badań klinicznych dotyczące braku związku między przestrzeganiem terapii PAP a śmiertelnością lub innymi wynikami klinicznymi. 52 Pomimo tego, badanie nadal nie wykazało istotnych różnic w wynikach między grupami przestrzegającymi i nieprzestrzegającymi terapii PAP. 53

Nowe perspektywy w prognozowaniu OBS

W niedalekiej przyszłości dokładność prognostyczna tych pomiarów w przewidywaniu długoterminowych powikłań w obturacyjnym bezdechu sennym prawdopodobnie się poprawi, wraz z lepszym dopasowaniem metod leczenia do podtypów choroby. 54 Czynniki te mogą pomóc lepiej zrozumieć patologiczną podstawę obturacyjnego bezdechu sennego i jego powikłań, poprawić prognozę długoterminowych skutków zdrowotnych oraz lepiej dopasować pacjentów do bardziej specyficznych metod leczenia. 55

Wysokie (34%) proporcje normalnych wyników potwierdza potrzebę wstępnej oceny przed polisomnografią, co sprawia, że poszukiwanie zwalidowanego modelu do badania przesiewowego pacjentów z podejrzeniem obturacyjnego bezdechu sennego jest niezbędne, szczególnie na poziomie podstawowej opieki zdrowotnej. 56 W tym wyniku klinicznym modele diagnostyczne muszą mieć wysoką czułość, ponieważ należy unikać wyników fałszywie ujemnych, aby zapobiec wykluczeniu pacjentów z umiarkowanym lub ciężkim OBS z wykonywania polisomnografii (PSG), standardowego testu do ostatecznej diagnozy OBS. 57

Najważniejszymi czynnikami ryzyka są: płeć, wiek, obwód szyi oraz nieprawidłowości twarzoczaszki i górnych dróg oddechowych, a czynnikami diagnostycznymi są: obserwowane bezdechy i nokturia. 58 Choć modele prognostyczne nie są doskonałe, mogą pomóc w identyfikacji ponad 90% pacjentów z OBS przy jednoczesnym wykluczeniu 25% zdrowych pacjentów, co złagodziłoby obciążenie służby zdrowia poprzez zmniejszenie liczby niepotrzebnych konsultacji i list oczekujących na polisomnografię. 59

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  1. 17.04.2026
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Materiały źródłowe

  • #1 Role of precision medicine in obstructive sleep apnoea | BMJ Medicine
    https://bmjmedicine.bmj.com/content/2/1/e000218
    Obstructive sleep apnoea is a substantial clinical and public health problem because it contributes to harmful effects on quality of life, daytime symptoms, road traffic incidents, and cardiometabolic disease. […] In the near future, the prognostic accuracy of these measures in predicting long term complications in obstructive sleep apnoea will likely be improved, together with better matching of treatments to disease subtypes. […] We believe that these factors might help us better understand the pathological basis of obstructive sleep apnoea and its complications, improve the prognosis for the long term effects on health, and better match patients to more specific treatments. […] Particular symptom subtypes were shown to be independent predictors of prevalent cardiovascular and cerebrovascular disease in moderate-to-severe obstructive sleep apnoea, and an increased risk of incident cardiovascular and cerebrovascular disease among patients with obstructive sleep apnoea (excessively sleepy subtype) was found.
  • #2
    https://link.springer.com/article/10.1007/s41060-018-0118-x
    In obstructive sleep apnea, respiratory effort is maintained but ventilation decreases/disappears due to upper-airway partial/total occlusion. This condition affects about 4% of men and 2% of women worldwide. […] The high (34%) proportion of normal results confirms the need for a pre-evaluation prior to polysomnography, making the search for a validated model to screen patients with suspicion of obstructive sleep apnea essential, especially at primary care level. […] In this clinical outcome, diagnostic models need to have a high sensitivity, as false negatives should be avoided, to prevent excluding patients with moderate or severe OSA from performing polysomnography (PSG), the standard test for OSA final diagnosis. […] This study is one of the first to build and validate risk models for OSA based solely on clinical and demographic variables, which have the key advantage of being easily available and quickly acquired.
  • #3 Obstructive Sleep Apnea (OSA): Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/295807-overview
    The short-term prognosis, in relation to symptoms such as daytime sleepiness and snoring, ranges from good to excellent with regular use of CPAP. Several studies, including placebo-controlled studies, have shown significant improvement in measures of cognitive function and general health status (eg, as measured by the Medical Outcome Study Short-Form 36 health survey) after 4-8 weeks of treatment with CPAP. However, studies have not been performed in a large population or for more than a 4- to 8-week treatment period. […] The long-term prognosis is unknown because no randomized treatment studies investigating the effect of CPAP on preventing the development of cardiovascular sequelae have been conducted. […] The effect of OSA on mortality has been investigated using observational cohort studies. Marin et al found in a Spanish cohort that severe untreated OSA (AHI 30) is associated with an increased risk of cardiovascular mortality, defined by fatal myocardial infarction (MI) or stroke. Patients with mild OSA or those undergoing treatment with CPAP did not have a significantly increased odds ratio compared with a group of subjects without OSA. […] All of the above evidence strongly suggests that OSA is an independent risk factor for the development of cardiovascular disease and death. However, at this time, no definitive randomized studies have investigated the effect of CPAP in preventing the potential cardiovascular risks.
  • #4 Obstructive Sleep Apnea (OSA): Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/295807-overview
    The short-term prognosis, in relation to symptoms such as daytime sleepiness and snoring, ranges from good to excellent with regular use of CPAP. Several studies, including placebo-controlled studies, have shown significant improvement in measures of cognitive function and general health status (eg, as measured by the Medical Outcome Study Short-Form 36 health survey) after 4-8 weeks of treatment with CPAP. However, studies have not been performed in a large population or for more than a 4- to 8-week treatment period. […] The long-term prognosis is unknown because no randomized treatment studies investigating the effect of CPAP on preventing the development of cardiovascular sequelae have been conducted. […] The effect of OSA on mortality has been investigated using observational cohort studies. Marin et al found in a Spanish cohort that severe untreated OSA (AHI 30) is associated with an increased risk of cardiovascular mortality, defined by fatal myocardial infarction (MI) or stroke. Patients with mild OSA or those undergoing treatment with CPAP did not have a significantly increased odds ratio compared with a group of subjects without OSA. […] All of the above evidence strongly suggests that OSA is an independent risk factor for the development of cardiovascular disease and death. However, at this time, no definitive randomized studies have investigated the effect of CPAP in preventing the potential cardiovascular risks.
  • #5 Obstructive Sleep Apnea (OSA): Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/295807-overview
    The short-term prognosis, in relation to symptoms such as daytime sleepiness and snoring, ranges from good to excellent with regular use of CPAP. Several studies, including placebo-controlled studies, have shown significant improvement in measures of cognitive function and general health status (eg, as measured by the Medical Outcome Study Short-Form 36 health survey) after 4-8 weeks of treatment with CPAP. However, studies have not been performed in a large population or for more than a 4- to 8-week treatment period. […] The long-term prognosis is unknown because no randomized treatment studies investigating the effect of CPAP on preventing the development of cardiovascular sequelae have been conducted. […] The effect of OSA on mortality has been investigated using observational cohort studies. Marin et al found in a Spanish cohort that severe untreated OSA (AHI 30) is associated with an increased risk of cardiovascular mortality, defined by fatal myocardial infarction (MI) or stroke. Patients with mild OSA or those undergoing treatment with CPAP did not have a significantly increased odds ratio compared with a group of subjects without OSA. […] All of the above evidence strongly suggests that OSA is an independent risk factor for the development of cardiovascular disease and death. However, at this time, no definitive randomized studies have investigated the effect of CPAP in preventing the potential cardiovascular risks.
  • #6 Obstructive Sleep Apnea (OSA): Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/295807-overview
    The short-term prognosis, in relation to symptoms such as daytime sleepiness and snoring, ranges from good to excellent with regular use of CPAP. Several studies, including placebo-controlled studies, have shown significant improvement in measures of cognitive function and general health status (eg, as measured by the Medical Outcome Study Short-Form 36 health survey) after 4-8 weeks of treatment with CPAP. However, studies have not been performed in a large population or for more than a 4- to 8-week treatment period. […] The long-term prognosis is unknown because no randomized treatment studies investigating the effect of CPAP on preventing the development of cardiovascular sequelae have been conducted. […] The effect of OSA on mortality has been investigated using observational cohort studies. Marin et al found in a Spanish cohort that severe untreated OSA (AHI 30) is associated with an increased risk of cardiovascular mortality, defined by fatal myocardial infarction (MI) or stroke. Patients with mild OSA or those undergoing treatment with CPAP did not have a significantly increased odds ratio compared with a group of subjects without OSA. […] All of the above evidence strongly suggests that OSA is an independent risk factor for the development of cardiovascular disease and death. However, at this time, no definitive randomized studies have investigated the effect of CPAP in preventing the potential cardiovascular risks.
  • #7 Obstructive Sleep Apnea (OSA): Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/295807-overview
    The short-term prognosis, in relation to symptoms such as daytime sleepiness and snoring, ranges from good to excellent with regular use of CPAP. Several studies, including placebo-controlled studies, have shown significant improvement in measures of cognitive function and general health status (eg, as measured by the Medical Outcome Study Short-Form 36 health survey) after 4-8 weeks of treatment with CPAP. However, studies have not been performed in a large population or for more than a 4- to 8-week treatment period. […] The long-term prognosis is unknown because no randomized treatment studies investigating the effect of CPAP on preventing the development of cardiovascular sequelae have been conducted. […] The effect of OSA on mortality has been investigated using observational cohort studies. Marin et al found in a Spanish cohort that severe untreated OSA (AHI 30) is associated with an increased risk of cardiovascular mortality, defined by fatal myocardial infarction (MI) or stroke. Patients with mild OSA or those undergoing treatment with CPAP did not have a significantly increased odds ratio compared with a group of subjects without OSA. […] All of the above evidence strongly suggests that OSA is an independent risk factor for the development of cardiovascular disease and death. However, at this time, no definitive randomized studies have investigated the effect of CPAP in preventing the potential cardiovascular risks.
  • #8 Obstructive Sleep Apnea (OSA): Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/295807-overview
    The short-term prognosis, in relation to symptoms such as daytime sleepiness and snoring, ranges from good to excellent with regular use of CPAP. Several studies, including placebo-controlled studies, have shown significant improvement in measures of cognitive function and general health status (eg, as measured by the Medical Outcome Study Short-Form 36 health survey) after 4-8 weeks of treatment with CPAP. However, studies have not been performed in a large population or for more than a 4- to 8-week treatment period. […] The long-term prognosis is unknown because no randomized treatment studies investigating the effect of CPAP on preventing the development of cardiovascular sequelae have been conducted. […] The effect of OSA on mortality has been investigated using observational cohort studies. Marin et al found in a Spanish cohort that severe untreated OSA (AHI 30) is associated with an increased risk of cardiovascular mortality, defined by fatal myocardial infarction (MI) or stroke. Patients with mild OSA or those undergoing treatment with CPAP did not have a significantly increased odds ratio compared with a group of subjects without OSA. […] All of the above evidence strongly suggests that OSA is an independent risk factor for the development of cardiovascular disease and death. However, at this time, no definitive randomized studies have investigated the effect of CPAP in preventing the potential cardiovascular risks.
  • #9 Clinical prediction models for the early diagnosis of obstructive sleep apnea in stroke patients: a systematic review | Systematic Reviews | Full Text
    https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-024-02449-9
    Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive cessation or reduction in airflow during sleep. Stroke patients have a higher risk of OSA, which can worsen their cognitive and functional disabilities, prolong their hospitalization, and increase their mortality rates. […] Previous studies found that OSA was associated with prolonged hospital stay, increased recurrence of stroke, and elevated mortality rates among stroke patients. […] The models developed for predicting OSA in stroke patients exhibited low to moderate performance, with a high risk of bias observed during quality assessment. Developing an accurate prediction model for OSA in stroke patients is challenging. […] Therefore, there is an urgent need for modeling studies with larger sample sizes and routine collection of electronic medical datasets to develop valid and accurate prediction tools for identifying the risk of OSA among vulnerable stroke patients.
  • #10 Clinical prediction models for the early diagnosis of obstructive sleep apnea in stroke patients: a systematic review | Systematic Reviews | Full Text
    https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-024-02449-9
    Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive cessation or reduction in airflow during sleep. Stroke patients have a higher risk of OSA, which can worsen their cognitive and functional disabilities, prolong their hospitalization, and increase their mortality rates. […] Previous studies found that OSA was associated with prolonged hospital stay, increased recurrence of stroke, and elevated mortality rates among stroke patients. […] The models developed for predicting OSA in stroke patients exhibited low to moderate performance, with a high risk of bias observed during quality assessment. Developing an accurate prediction model for OSA in stroke patients is challenging. […] Therefore, there is an urgent need for modeling studies with larger sample sizes and routine collection of electronic medical datasets to develop valid and accurate prediction tools for identifying the risk of OSA among vulnerable stroke patients.
  • #11 Obstructive Sleep Apnea (OSA): Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/24443-obstructive-sleep-apnea-osa
    Untreated OSA may reduce your life expectancy and increase your risk of dangerous complications. But OSA is a treatable condition. A healthcare provider is the best person to talk to about what you can expect, as this answer is very unique to you. […] The outlook for OSA depends on many factors like the severity and whether you have other underlying conditions, too. However, you can expect a positive outcome if you stick to your treatment plan after you and your healthcare provider find one that works best for you.
  • #12 Obstructive Sleep Apnea (OSA): Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/24443-obstructive-sleep-apnea-osa
    Untreated OSA may reduce your life expectancy and increase your risk of dangerous complications. But OSA is a treatable condition. A healthcare provider is the best person to talk to about what you can expect, as this answer is very unique to you. […] The outlook for OSA depends on many factors like the severity and whether you have other underlying conditions, too. However, you can expect a positive outcome if you stick to your treatment plan after you and your healthcare provider find one that works best for you.
  • #13 Obstructive Sleep Apnea (OSA): Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/24443-obstructive-sleep-apnea-osa
    Untreated OSA may reduce your life expectancy and increase your risk of dangerous complications. But OSA is a treatable condition. A healthcare provider is the best person to talk to about what you can expect, as this answer is very unique to you. […] The outlook for OSA depends on many factors like the severity and whether you have other underlying conditions, too. However, you can expect a positive outcome if you stick to your treatment plan after you and your healthcare provider find one that works best for you.
  • #14 Development and assessment of a risk prediction model for moderate-to-severe obstructive sleep apnea
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9390335/
    OSA is an independent risk factor for several systemic diseases. […] Compared with mild OSA, patients with moderate-to-severe OSA have more severe impairment in the function of all organs of the body. […] The prediction model obtained in this study has good predictive power for moderate-to-severe OSA and is superior to other prediction models and questionnaires. […] The model has good consistency in predicting the actual occurrence of moderate-to-severe risk, and has good prediction accuracy. […] The DCA shows that the net benefit of the nomogram model is higher than that of SBQ and NoSAS, with has good clinical utility. […] The AUC of this prediction model was 0.976 (95% CI: 0.9620.990). […] The model developed in this study was based on the severity of OSA and the results of this study differed from previous studies, possibly due to different groupings, and future prediction models could attempt to link to AHI.
  • #15 Development and assessment of a risk prediction model for moderate-to-severe obstructive sleep apnea
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9390335/
    OSA is an independent risk factor for several systemic diseases. […] Compared with mild OSA, patients with moderate-to-severe OSA have more severe impairment in the function of all organs of the body. […] The prediction model obtained in this study has good predictive power for moderate-to-severe OSA and is superior to other prediction models and questionnaires. […] The model has good consistency in predicting the actual occurrence of moderate-to-severe risk, and has good prediction accuracy. […] The DCA shows that the net benefit of the nomogram model is higher than that of SBQ and NoSAS, with has good clinical utility. […] The AUC of this prediction model was 0.976 (95% CI: 0.9620.990). […] The model developed in this study was based on the severity of OSA and the results of this study differed from previous studies, possibly due to different groupings, and future prediction models could attempt to link to AHI.
  • #16 Development and assessment of a risk prediction model for moderate-to-severe obstructive sleep apnea
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9390335/
    OSA is an independent risk factor for several systemic diseases. […] Compared with mild OSA, patients with moderate-to-severe OSA have more severe impairment in the function of all organs of the body. […] The prediction model obtained in this study has good predictive power for moderate-to-severe OSA and is superior to other prediction models and questionnaires. […] The model has good consistency in predicting the actual occurrence of moderate-to-severe risk, and has good prediction accuracy. […] The DCA shows that the net benefit of the nomogram model is higher than that of SBQ and NoSAS, with has good clinical utility. […] The AUC of this prediction model was 0.976 (95% CI: 0.9620.990). […] The model developed in this study was based on the severity of OSA and the results of this study differed from previous studies, possibly due to different groupings, and future prediction models could attempt to link to AHI.
  • #17 Development and assessment of a risk prediction model for moderate-to-severe obstructive sleep apnea
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9390335/
    OSA is an independent risk factor for several systemic diseases. […] Compared with mild OSA, patients with moderate-to-severe OSA have more severe impairment in the function of all organs of the body. […] The prediction model obtained in this study has good predictive power for moderate-to-severe OSA and is superior to other prediction models and questionnaires. […] The model has good consistency in predicting the actual occurrence of moderate-to-severe risk, and has good prediction accuracy. […] The DCA shows that the net benefit of the nomogram model is higher than that of SBQ and NoSAS, with has good clinical utility. […] The AUC of this prediction model was 0.976 (95% CI: 0.9620.990). […] The model developed in this study was based on the severity of OSA and the results of this study differed from previous studies, possibly due to different groupings, and future prediction models could attempt to link to AHI.
  • #18 Development and assessment of a risk prediction model for moderate-to-severe obstructive sleep apnea
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9390335/
    OSA is an independent risk factor for several systemic diseases. […] Compared with mild OSA, patients with moderate-to-severe OSA have more severe impairment in the function of all organs of the body. […] The prediction model obtained in this study has good predictive power for moderate-to-severe OSA and is superior to other prediction models and questionnaires. […] The model has good consistency in predicting the actual occurrence of moderate-to-severe risk, and has good prediction accuracy. […] The DCA shows that the net benefit of the nomogram model is higher than that of SBQ and NoSAS, with has good clinical utility. […] The AUC of this prediction model was 0.976 (95% CI: 0.9620.990). […] The model developed in this study was based on the severity of OSA and the results of this study differed from previous studies, possibly due to different groupings, and future prediction models could attempt to link to AHI.
  • #19 Development and assessment of a risk prediction model for moderate-to-severe obstructive sleep apnea
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9390335/
    OSA is an independent risk factor for several systemic diseases. […] Compared with mild OSA, patients with moderate-to-severe OSA have more severe impairment in the function of all organs of the body. […] The prediction model obtained in this study has good predictive power for moderate-to-severe OSA and is superior to other prediction models and questionnaires. […] The model has good consistency in predicting the actual occurrence of moderate-to-severe risk, and has good prediction accuracy. […] The DCA shows that the net benefit of the nomogram model is higher than that of SBQ and NoSAS, with has good clinical utility. […] The AUC of this prediction model was 0.976 (95% CI: 0.9620.990). […] The model developed in this study was based on the severity of OSA and the results of this study differed from previous studies, possibly due to different groupings, and future prediction models could attempt to link to AHI.
  • #20 Application of various machine learning techniques to predict obstructive sleep apnea syndrome severity | Scientific Reports
    https://www.nature.com/articles/s41598-023-33170-7
    As the incidence of obstructive sleep apnea syndrome (OSAS) increases worldwide, the need for a new screening method that can compensate for the shortcomings of the traditional diagnostic method, polysomnography (PSG), is emerging. […] The results of this study demonstrate significant evidence of sufficient potential to utilize machine learning in predicting OSAS severity. […] This study aims to present models that can predict the severity of OSAS without performing PSG using assorted machine learning algorithms, in both supervised and unsupervised learning. […] The prediction results with clustering showed significantly superior performance compared to the prediction results without clustering. […] Our work provides the basis for confirming the sufficient potential for utilizing machine learning in OSAS severity prediction, and also suggests outcome prediction models may be useful for screening priorities that assign patients to PSG. […] The results of this work demonstrate the superiority of OSAS screening applicability using machine learning methods.
  • #21 Application of various machine learning techniques to predict obstructive sleep apnea syndrome severity | Scientific Reports
    https://www.nature.com/articles/s41598-023-33170-7
    As the incidence of obstructive sleep apnea syndrome (OSAS) increases worldwide, the need for a new screening method that can compensate for the shortcomings of the traditional diagnostic method, polysomnography (PSG), is emerging. […] The results of this study demonstrate significant evidence of sufficient potential to utilize machine learning in predicting OSAS severity. […] This study aims to present models that can predict the severity of OSAS without performing PSG using assorted machine learning algorithms, in both supervised and unsupervised learning. […] The prediction results with clustering showed significantly superior performance compared to the prediction results without clustering. […] Our work provides the basis for confirming the sufficient potential for utilizing machine learning in OSAS severity prediction, and also suggests outcome prediction models may be useful for screening priorities that assign patients to PSG. […] The results of this work demonstrate the superiority of OSAS screening applicability using machine learning methods.
  • #22 Mount Sinai to develop sleep apnea outcome risk prediction models | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366589981/Mount-Sinai-to-develop-sleep-apnea-outcome-risk-prediction-models
    Researchers from Mount Sinai have been awarded a four-year, $3 million grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) to develop artificial intelligence (AI)-driven prediction models to flag risk of cardiovascular disease events in patients with obstructive sleep apnea. […] The American Heart Association (AHA) indicates that obstructive sleep apnea increases patients risk of cardiovascular disease, including coronary artery disease, hypertension and stroke. […] To bridge this gap, the research team will build machine learning (ML) tools to identify obstructive sleep apnea patients at high risk for atherosclerosis progression and cardiovascular events like stroke and heart attack. […] The researchers underscored that this approach could help forecast cardiovascular treatment effectiveness of CPAP use in patients considered non-sleepy based on their responses to a clinical test.
  • #23 Mount Sinai to develop sleep apnea outcome risk prediction models | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366589981/Mount-Sinai-to-develop-sleep-apnea-outcome-risk-prediction-models
    Researchers from Mount Sinai have been awarded a four-year, $3 million grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) to develop artificial intelligence (AI)-driven prediction models to flag risk of cardiovascular disease events in patients with obstructive sleep apnea. […] The American Heart Association (AHA) indicates that obstructive sleep apnea increases patients risk of cardiovascular disease, including coronary artery disease, hypertension and stroke. […] To bridge this gap, the research team will build machine learning (ML) tools to identify obstructive sleep apnea patients at high risk for atherosclerosis progression and cardiovascular events like stroke and heart attack. […] The researchers underscored that this approach could help forecast cardiovascular treatment effectiveness of CPAP use in patients considered non-sleepy based on their responses to a clinical test.
  • #24 Mount Sinai to develop sleep apnea outcome risk prediction models | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366589981/Mount-Sinai-to-develop-sleep-apnea-outcome-risk-prediction-models
    Researchers from Mount Sinai have been awarded a four-year, $3 million grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) to develop artificial intelligence (AI)-driven prediction models to flag risk of cardiovascular disease events in patients with obstructive sleep apnea. […] The American Heart Association (AHA) indicates that obstructive sleep apnea increases patients risk of cardiovascular disease, including coronary artery disease, hypertension and stroke. […] To bridge this gap, the research team will build machine learning (ML) tools to identify obstructive sleep apnea patients at high risk for atherosclerosis progression and cardiovascular events like stroke and heart attack. […] The researchers underscored that this approach could help forecast cardiovascular treatment effectiveness of CPAP use in patients considered non-sleepy based on their responses to a clinical test.
  • #25 Mount Sinai to develop sleep apnea outcome risk prediction models | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366589981/Mount-Sinai-to-develop-sleep-apnea-outcome-risk-prediction-models
    These data will be used to flag key predictors of atherosclerosis progression and cardiovascular events alongside identifying risk-based patient subgroups with differential CPAP treatment outcomes for cardiovascular events. […] Health care providers will be equipped with innovative tools to identify patients at heightened risk for heart attack or stroke and be able to predict treatment outcomes of CPAP therapy in sleep apnea patients. […] The researchers noted that current diagnostic tools for sleep apnea which typically rely on counting the number of breathing disturbances a patient experiences during sleep are not accurate predictors of short- and long-term adverse outcomes like excessive daytime sleepiness, cardio-cerebrovascular morbidity and neurocognitive impairment. […] The AI models are designed to address the shortcomings of these tools by analyzing hypoxic, arousal and ventilatory variables to generate a personalized patient risk score.
  • #26 Mount Sinai to develop sleep apnea outcome risk prediction models | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366589981/Mount-Sinai-to-develop-sleep-apnea-outcome-risk-prediction-models
    These data will be used to flag key predictors of atherosclerosis progression and cardiovascular events alongside identifying risk-based patient subgroups with differential CPAP treatment outcomes for cardiovascular events. […] Health care providers will be equipped with innovative tools to identify patients at heightened risk for heart attack or stroke and be able to predict treatment outcomes of CPAP therapy in sleep apnea patients. […] The researchers noted that current diagnostic tools for sleep apnea which typically rely on counting the number of breathing disturbances a patient experiences during sleep are not accurate predictors of short- and long-term adverse outcomes like excessive daytime sleepiness, cardio-cerebrovascular morbidity and neurocognitive impairment. […] The AI models are designed to address the shortcomings of these tools by analyzing hypoxic, arousal and ventilatory variables to generate a personalized patient risk score.
  • #27 Mount Sinai to develop sleep apnea outcome risk prediction models | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366589981/Mount-Sinai-to-develop-sleep-apnea-outcome-risk-prediction-models
    These data will be used to flag key predictors of atherosclerosis progression and cardiovascular events alongside identifying risk-based patient subgroups with differential CPAP treatment outcomes for cardiovascular events. […] Health care providers will be equipped with innovative tools to identify patients at heightened risk for heart attack or stroke and be able to predict treatment outcomes of CPAP therapy in sleep apnea patients. […] The researchers noted that current diagnostic tools for sleep apnea which typically rely on counting the number of breathing disturbances a patient experiences during sleep are not accurate predictors of short- and long-term adverse outcomes like excessive daytime sleepiness, cardio-cerebrovascular morbidity and neurocognitive impairment. […] The AI models are designed to address the shortcomings of these tools by analyzing hypoxic, arousal and ventilatory variables to generate a personalized patient risk score.
  • #28 $4M Grant to Fund Development of Sleep Apnea Outcome Prediction Tools | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366590064/4M-Grant-to-Fund-Development-of-Sleep-Apnea-Outcome-Prediction-Tools
    Researchers from Mount Sinai have been awarded $4.1 million from the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) to develop artificial intelligence (AI) models to predict adverse outcomes in obstructive sleep apnea. […] However, the AHI is limited and is not necessarily an accurate predictor of patient outcomes, leading clinicians to call for the development of improved diagnostic and prognostic tools. […] The approach looks at the underlying physiology of the condition and some of the sleep functions it impairs sleep stages, breathing, and oxygen levels to generate a risk score that helps predict patients short- and long-term outcomes, such as excessive daytime sleepiness, neurocognitive impairment, and cardio-cerebrovascular morbidity.
  • #29 $4M Grant to Fund Development of Sleep Apnea Outcome Prediction Tools | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366590064/4M-Grant-to-Fund-Development-of-Sleep-Apnea-Outcome-Prediction-Tools
    Researchers from Mount Sinai have been awarded $4.1 million from the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) to develop artificial intelligence (AI) models to predict adverse outcomes in obstructive sleep apnea. […] However, the AHI is limited and is not necessarily an accurate predictor of patient outcomes, leading clinicians to call for the development of improved diagnostic and prognostic tools. […] The approach looks at the underlying physiology of the condition and some of the sleep functions it impairs sleep stages, breathing, and oxygen levels to generate a risk score that helps predict patients short- and long-term outcomes, such as excessive daytime sleepiness, neurocognitive impairment, and cardio-cerebrovascular morbidity.
  • #30 $4M Grant to Fund Development of Sleep Apnea Outcome Prediction Tools | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366590064/4M-Grant-to-Fund-Development-of-Sleep-Apnea-Outcome-Prediction-Tools
    The findings of this analysis revealed that one of the models could accurately predict the probability of sleepiness due to apnea with an accuracy of about 87 percent, whereas a model using the AHI could predict the same metric with an accuracy of only 54 percent. […] In a cohort of 4,700 participants, the AI approach could predict cardiovascular mortality with over 80 percent accuracy compared to the standard approach, which achieved only 58 percent accuracy. […] Our study will assess the real-world performance of an AI approach and offer crucial evidence needed to translate metrics that go beyond the apnea-hypopnea [index] in assessing severity of obstructive sleep apnea into clinical practice. Achieving this would leave us poised to shift the paradigm in clinical management of obstructive sleep apnea, Parekh continued. […] The findings of this study will then be retrospectively validated for further statistical analysis.
  • #31 $4M Grant to Fund Development of Sleep Apnea Outcome Prediction Tools | TechTarget
    https://www.techtarget.com/healthtechanalytics/news/366590064/4M-Grant-to-Fund-Development-of-Sleep-Apnea-Outcome-Prediction-Tools
    The findings of this analysis revealed that one of the models could accurately predict the probability of sleepiness due to apnea with an accuracy of about 87 percent, whereas a model using the AHI could predict the same metric with an accuracy of only 54 percent. […] In a cohort of 4,700 participants, the AI approach could predict cardiovascular mortality with over 80 percent accuracy compared to the standard approach, which achieved only 58 percent accuracy. […] Our study will assess the real-world performance of an AI approach and offer crucial evidence needed to translate metrics that go beyond the apnea-hypopnea [index] in assessing severity of obstructive sleep apnea into clinical practice. Achieving this would leave us poised to shift the paradigm in clinical management of obstructive sleep apnea, Parekh continued. […] The findings of this study will then be retrospectively validated for further statistical analysis.
  • #32 Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment | Thorax
    https://thorax.bmj.com/content/78/1/76
    There is a growing awareness of the heterogeneity of obstructive sleep apnoea (OSA). […] Clinical trials of CPAP treatment on cardiovascular protection have been mostly negative. […] We aimed to assess the association between polysomnographic parameters and incident major adverse cardiovascular events (MACEs), and to investigate if the CPAP effect could be better delineated among clinical subgroups. […] Apnoea-hypopnoea index (AHI) did not predict MACEs (HR: 0.95; 95% CI 0.76 to 1.17), whereas sleep time with oxygen saturation 90% (TST90) (HR: 1.41; 95% CI 1.10 to 1.81) was an independent predictor of MACEs, as were wake and nocturnal heart rate. […] In moderate-severe OSA (n=1108) who were indicated for CPAP treatment, regular CPAP was not associated with reduction of incident MACEs.
  • #33 Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment | Thorax
    https://thorax.bmj.com/content/78/1/76
    OSA-related TST90 and mean heart rate, but not AHI, were robust predictors of MACEs. […] A clinical phenotype subgroup who demonstrated beneficial effect of CPAP treatment was identified. […] Sleep-apnoea related hypoxia and mean heart rate, but not apnoea-hypopnoea index (AHI) are likely to be dominant predictors of adverse cardiovascular outcomes. […] Not all patients with moderate-severe OSA according to AHI criteria benefited uniformly from regular CPAP therapy, but those who were younger with greater nocturnal hypoxaemia, higher AHI and other concurrent cardiovascular risk factors demonstrated a lower incidence of cardiovascular events with regular CPAP treatment. […] The aims of the current study were to determine the association between various polysomnographic measures of OSA and incident major adverse cardiovascular events (MACEs) in a sleep clinic cohort, and to evaluate the impact of CPAP therapy which has been prescribed per usual criteria in consensus recommendations, based on consideration of AHI, symptoms and background cardiovascular disease (CVD) risks.
  • #34 Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment | Thorax
    https://thorax.bmj.com/content/78/1/76
    There is a growing awareness of the heterogeneity of obstructive sleep apnoea (OSA). […] Clinical trials of CPAP treatment on cardiovascular protection have been mostly negative. […] We aimed to assess the association between polysomnographic parameters and incident major adverse cardiovascular events (MACEs), and to investigate if the CPAP effect could be better delineated among clinical subgroups. […] Apnoea-hypopnoea index (AHI) did not predict MACEs (HR: 0.95; 95% CI 0.76 to 1.17), whereas sleep time with oxygen saturation 90% (TST90) (HR: 1.41; 95% CI 1.10 to 1.81) was an independent predictor of MACEs, as were wake and nocturnal heart rate. […] In moderate-severe OSA (n=1108) who were indicated for CPAP treatment, regular CPAP was not associated with reduction of incident MACEs.
  • #35 Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment | Thorax
    https://thorax.bmj.com/content/78/1/76
    OSA-related TST90 and mean heart rate, but not AHI, were robust predictors of MACEs. […] A clinical phenotype subgroup who demonstrated beneficial effect of CPAP treatment was identified. […] Sleep-apnoea related hypoxia and mean heart rate, but not apnoea-hypopnoea index (AHI) are likely to be dominant predictors of adverse cardiovascular outcomes. […] Not all patients with moderate-severe OSA according to AHI criteria benefited uniformly from regular CPAP therapy, but those who were younger with greater nocturnal hypoxaemia, higher AHI and other concurrent cardiovascular risk factors demonstrated a lower incidence of cardiovascular events with regular CPAP treatment. […] The aims of the current study were to determine the association between various polysomnographic measures of OSA and incident major adverse cardiovascular events (MACEs) in a sleep clinic cohort, and to evaluate the impact of CPAP therapy which has been prescribed per usual criteria in consensus recommendations, based on consideration of AHI, symptoms and background cardiovascular disease (CVD) risks.
  • #36 Point-of-care prediction model of loop gain in patients with obstructive sleep apnea: development and validation | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-01950-y
    High loop gain (unstable ventilatory control) is an important but difficult to measure contributor to obstructive sleep apnea (OSA) pathogenesis, predicting OSA sequelae and/or treatment response. […] The predicted loop gain showed moderate-to-high correlation with the reference loop gain (r=0.48; 95% CI 0.380.57) and moderate discrimination of patients with high versus low loop gain (area under the curve=0.73; 95% CI 0.670.80). […] To our knowledge this is the first prediction model of loop gain based on readily-available clinical data, which may facilitate retrospective analyses of existing datasets, better patient selection for clinical trials and eventually clinical practice. […] This prediction model may facilitate better patient selection for clinical trials: patients predicted to have high loop could be preferentially selected for studies of loop gain lowering interventions (i.e., acetazolamide, oxygen), but be excluded from interventions that target other traits such as anatomy (i.e., upper airway surgery, oral appliance, hypoglossal nerve stimulation).
  • #37 Point-of-care prediction model of loop gain in patients with obstructive sleep apnea: development and validation | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-01950-y
    High loop gain (unstable ventilatory control) is an important but difficult to measure contributor to obstructive sleep apnea (OSA) pathogenesis, predicting OSA sequelae and/or treatment response. […] The predicted loop gain showed moderate-to-high correlation with the reference loop gain (r=0.48; 95% CI 0.380.57) and moderate discrimination of patients with high versus low loop gain (area under the curve=0.73; 95% CI 0.670.80). […] To our knowledge this is the first prediction model of loop gain based on readily-available clinical data, which may facilitate retrospective analyses of existing datasets, better patient selection for clinical trials and eventually clinical practice. […] This prediction model may facilitate better patient selection for clinical trials: patients predicted to have high loop could be preferentially selected for studies of loop gain lowering interventions (i.e., acetazolamide, oxygen), but be excluded from interventions that target other traits such as anatomy (i.e., upper airway surgery, oral appliance, hypoglossal nerve stimulation).
  • #38 Point-of-care prediction model of loop gain in patients with obstructive sleep apnea: development and validation | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-01950-y
    High loop gain (unstable ventilatory control) is an important but difficult to measure contributor to obstructive sleep apnea (OSA) pathogenesis, predicting OSA sequelae and/or treatment response. […] The predicted loop gain showed moderate-to-high correlation with the reference loop gain (r=0.48; 95% CI 0.380.57) and moderate discrimination of patients with high versus low loop gain (area under the curve=0.73; 95% CI 0.670.80). […] To our knowledge this is the first prediction model of loop gain based on readily-available clinical data, which may facilitate retrospective analyses of existing datasets, better patient selection for clinical trials and eventually clinical practice. […] This prediction model may facilitate better patient selection for clinical trials: patients predicted to have high loop could be preferentially selected for studies of loop gain lowering interventions (i.e., acetazolamide, oxygen), but be excluded from interventions that target other traits such as anatomy (i.e., upper airway surgery, oral appliance, hypoglossal nerve stimulation).
  • #39 Point-of-care prediction model of loop gain in patients with obstructive sleep apnea: development and validation | BMC Pulmonary Medicine | Full Text
    https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-01950-y
    High loop gain (unstable ventilatory control) is an important but difficult to measure contributor to obstructive sleep apnea (OSA) pathogenesis, predicting OSA sequelae and/or treatment response. […] The predicted loop gain showed moderate-to-high correlation with the reference loop gain (r=0.48; 95% CI 0.380.57) and moderate discrimination of patients with high versus low loop gain (area under the curve=0.73; 95% CI 0.670.80). […] To our knowledge this is the first prediction model of loop gain based on readily-available clinical data, which may facilitate retrospective analyses of existing datasets, better patient selection for clinical trials and eventually clinical practice. […] This prediction model may facilitate better patient selection for clinical trials: patients predicted to have high loop could be preferentially selected for studies of loop gain lowering interventions (i.e., acetazolamide, oxygen), but be excluded from interventions that target other traits such as anatomy (i.e., upper airway surgery, oral appliance, hypoglossal nerve stimulation).
  • #40 Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment | Thorax
    https://thorax.bmj.com/content/78/1/76
    There is a growing awareness of the heterogeneity of obstructive sleep apnoea (OSA). […] Clinical trials of CPAP treatment on cardiovascular protection have been mostly negative. […] We aimed to assess the association between polysomnographic parameters and incident major adverse cardiovascular events (MACEs), and to investigate if the CPAP effect could be better delineated among clinical subgroups. […] Apnoea-hypopnoea index (AHI) did not predict MACEs (HR: 0.95; 95% CI 0.76 to 1.17), whereas sleep time with oxygen saturation 90% (TST90) (HR: 1.41; 95% CI 1.10 to 1.81) was an independent predictor of MACEs, as were wake and nocturnal heart rate. […] In moderate-severe OSA (n=1108) who were indicated for CPAP treatment, regular CPAP was not associated with reduction of incident MACEs.
  • #41 Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment | Thorax
    https://thorax.bmj.com/content/78/1/76
    Regular CPAP treatment was not associated with a lower rate of MACEs, but cluster analysis based on baseline clinical and PSG features identified a high-risk subgroup who could benefit from regular CPAP treatment. […] The findings further support that awareness of the heterogeneity of OSA would allow for better identification of those at risk of specific adverse health outcomes and those who are most likely to benefit from CPAP treatment.
  • #42 Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment | Thorax
    https://thorax.bmj.com/content/78/1/76
    Regular CPAP treatment was not associated with a lower rate of MACEs, but cluster analysis based on baseline clinical and PSG features identified a high-risk subgroup who could benefit from regular CPAP treatment. […] The findings further support that awareness of the heterogeneity of OSA would allow for better identification of those at risk of specific adverse health outcomes and those who are most likely to benefit from CPAP treatment.
  • #43 Role of precision medicine in obstructive sleep apnoea | BMJ Medicine
    https://bmjmedicine.bmj.com/content/2/1/e000218
    Obstructive sleep apnoea is a substantial clinical and public health problem because it contributes to harmful effects on quality of life, daytime symptoms, road traffic incidents, and cardiometabolic disease. […] In the near future, the prognostic accuracy of these measures in predicting long term complications in obstructive sleep apnoea will likely be improved, together with better matching of treatments to disease subtypes. […] We believe that these factors might help us better understand the pathological basis of obstructive sleep apnoea and its complications, improve the prognosis for the long term effects on health, and better match patients to more specific treatments. […] Particular symptom subtypes were shown to be independent predictors of prevalent cardiovascular and cerebrovascular disease in moderate-to-severe obstructive sleep apnoea, and an increased risk of incident cardiovascular and cerebrovascular disease among patients with obstructive sleep apnoea (excessively sleepy subtype) was found.
  • #44 Role of precision medicine in obstructive sleep apnoea | BMJ Medicine
    https://bmjmedicine.bmj.com/content/2/1/e000218
    Further clarification of specific physiological endotypes in individuals with obstructive sleep apnoea might facilitate the development of new treatments that can be tailored to individual patient needs according to the physiological endotype or endotypes of their disease. […] Hence these endotypes could help in identifying patients who might have greater improvements in symptoms and more robust responses to specific treatments for obstructive sleep apnoea. […] A more precise molecular phenotyping of obstructive sleep apnoea with these and other markers could provide a more nuanced representation of the disease. Ultimately, this advanced phenotyping might provide more accurate care, matching precise subtypes to specific treatments.
  • #45 Role of precision medicine in obstructive sleep apnoea | BMJ Medicine
    https://bmjmedicine.bmj.com/content/2/1/e000218
    Further clarification of specific physiological endotypes in individuals with obstructive sleep apnoea might facilitate the development of new treatments that can be tailored to individual patient needs according to the physiological endotype or endotypes of their disease. […] Hence these endotypes could help in identifying patients who might have greater improvements in symptoms and more robust responses to specific treatments for obstructive sleep apnoea. […] A more precise molecular phenotyping of obstructive sleep apnoea with these and other markers could provide a more nuanced representation of the disease. Ultimately, this advanced phenotyping might provide more accurate care, matching precise subtypes to specific treatments.
  • #46 Role of precision medicine in obstructive sleep apnoea | BMJ Medicine
    https://bmjmedicine.bmj.com/content/2/1/e000218
    Further clarification of specific physiological endotypes in individuals with obstructive sleep apnoea might facilitate the development of new treatments that can be tailored to individual patient needs according to the physiological endotype or endotypes of their disease. […] Hence these endotypes could help in identifying patients who might have greater improvements in symptoms and more robust responses to specific treatments for obstructive sleep apnoea. […] A more precise molecular phenotyping of obstructive sleep apnoea with these and other markers could provide a more nuanced representation of the disease. Ultimately, this advanced phenotyping might provide more accurate care, matching precise subtypes to specific treatments.
  • #47 Role of precision medicine in obstructive sleep apnoea | BMJ Medicine
    https://bmjmedicine.bmj.com/content/2/1/e000218
    Further clarification of specific physiological endotypes in individuals with obstructive sleep apnoea might facilitate the development of new treatments that can be tailored to individual patient needs according to the physiological endotype or endotypes of their disease. […] Hence these endotypes could help in identifying patients who might have greater improvements in symptoms and more robust responses to specific treatments for obstructive sleep apnoea. […] A more precise molecular phenotyping of obstructive sleep apnoea with these and other markers could provide a more nuanced representation of the disease. Ultimately, this advanced phenotyping might provide more accurate care, matching precise subtypes to specific treatments.
  • #48 Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review | Published in Canadian Journal of Respiratory Therapy
    https://cjrt.ca/article/92080-positive-airway-pressure-therapy-adherence-and-outcomes-in-obstructive-sleep-apnea-an-exploratory-longitudinal-retrospective-randomized-chart-review
    Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). […] The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful. […] Our study showed no significant differences between the PAP therapy adherent and non-adherent groups for mortality, length of stay in hospital, and number of hospitalizations during the eight-year study observation period. […] The present study supports the findings of previous RCTs regarding the lack of association between PAP therapy adherence and mortality or other clinical outcomes. […] Despite this, our study still didn’t find significant differences in outcomes between the PAP therapy adherent and non-adherent groups. […] This exploratory study warrants that further studies be conducted to investigate clinically meaningful criteria for PAP therapy adherence.
  • #49 Cardiovascular outcomes in obstructive sleep apnoea and implications of clinical phenotyping on effect of CPAP treatment | Thorax
    https://thorax.bmj.com/content/78/1/76
    There is a growing awareness of the heterogeneity of obstructive sleep apnoea (OSA). […] Clinical trials of CPAP treatment on cardiovascular protection have been mostly negative. […] We aimed to assess the association between polysomnographic parameters and incident major adverse cardiovascular events (MACEs), and to investigate if the CPAP effect could be better delineated among clinical subgroups. […] Apnoea-hypopnoea index (AHI) did not predict MACEs (HR: 0.95; 95% CI 0.76 to 1.17), whereas sleep time with oxygen saturation 90% (TST90) (HR: 1.41; 95% CI 1.10 to 1.81) was an independent predictor of MACEs, as were wake and nocturnal heart rate. […] In moderate-severe OSA (n=1108) who were indicated for CPAP treatment, regular CPAP was not associated with reduction of incident MACEs.
  • #50 Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review | Published in Canadian Journal of Respiratory Therapy
    https://cjrt.ca/article/92080-positive-airway-pressure-therapy-adherence-and-outcomes-in-obstructive-sleep-apnea-an-exploratory-longitudinal-retrospective-randomized-chart-review
    Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). […] The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful. […] Our study showed no significant differences between the PAP therapy adherent and non-adherent groups for mortality, length of stay in hospital, and number of hospitalizations during the eight-year study observation period. […] The present study supports the findings of previous RCTs regarding the lack of association between PAP therapy adherence and mortality or other clinical outcomes. […] Despite this, our study still didn’t find significant differences in outcomes between the PAP therapy adherent and non-adherent groups. […] This exploratory study warrants that further studies be conducted to investigate clinically meaningful criteria for PAP therapy adherence.
  • #51 Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review | Published in Canadian Journal of Respiratory Therapy
    https://cjrt.ca/article/92080-positive-airway-pressure-therapy-adherence-and-outcomes-in-obstructive-sleep-apnea-an-exploratory-longitudinal-retrospective-randomized-chart-review
    Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). […] The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful. […] Our study showed no significant differences between the PAP therapy adherent and non-adherent groups for mortality, length of stay in hospital, and number of hospitalizations during the eight-year study observation period. […] The present study supports the findings of previous RCTs regarding the lack of association between PAP therapy adherence and mortality or other clinical outcomes. […] Despite this, our study still didn’t find significant differences in outcomes between the PAP therapy adherent and non-adherent groups. […] This exploratory study warrants that further studies be conducted to investigate clinically meaningful criteria for PAP therapy adherence.
  • #52 Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review | Published in Canadian Journal of Respiratory Therapy
    https://cjrt.ca/article/92080-positive-airway-pressure-therapy-adherence-and-outcomes-in-obstructive-sleep-apnea-an-exploratory-longitudinal-retrospective-randomized-chart-review
    Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). […] The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful. […] Our study showed no significant differences between the PAP therapy adherent and non-adherent groups for mortality, length of stay in hospital, and number of hospitalizations during the eight-year study observation period. […] The present study supports the findings of previous RCTs regarding the lack of association between PAP therapy adherence and mortality or other clinical outcomes. […] Despite this, our study still didn’t find significant differences in outcomes between the PAP therapy adherent and non-adherent groups. […] This exploratory study warrants that further studies be conducted to investigate clinically meaningful criteria for PAP therapy adherence.
  • #53 Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review | Published in Canadian Journal of Respiratory Therapy
    https://cjrt.ca/article/92080-positive-airway-pressure-therapy-adherence-and-outcomes-in-obstructive-sleep-apnea-an-exploratory-longitudinal-retrospective-randomized-chart-review
    Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). […] The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful. […] Our study showed no significant differences between the PAP therapy adherent and non-adherent groups for mortality, length of stay in hospital, and number of hospitalizations during the eight-year study observation period. […] The present study supports the findings of previous RCTs regarding the lack of association between PAP therapy adherence and mortality or other clinical outcomes. […] Despite this, our study still didn’t find significant differences in outcomes between the PAP therapy adherent and non-adherent groups. […] This exploratory study warrants that further studies be conducted to investigate clinically meaningful criteria for PAP therapy adherence.
  • #54 Role of precision medicine in obstructive sleep apnoea | BMJ Medicine
    https://bmjmedicine.bmj.com/content/2/1/e000218
    Obstructive sleep apnoea is a substantial clinical and public health problem because it contributes to harmful effects on quality of life, daytime symptoms, road traffic incidents, and cardiometabolic disease. […] In the near future, the prognostic accuracy of these measures in predicting long term complications in obstructive sleep apnoea will likely be improved, together with better matching of treatments to disease subtypes. […] We believe that these factors might help us better understand the pathological basis of obstructive sleep apnoea and its complications, improve the prognosis for the long term effects on health, and better match patients to more specific treatments. […] Particular symptom subtypes were shown to be independent predictors of prevalent cardiovascular and cerebrovascular disease in moderate-to-severe obstructive sleep apnoea, and an increased risk of incident cardiovascular and cerebrovascular disease among patients with obstructive sleep apnoea (excessively sleepy subtype) was found.
  • #55 Role of precision medicine in obstructive sleep apnoea | BMJ Medicine
    https://bmjmedicine.bmj.com/content/2/1/e000218
    Obstructive sleep apnoea is a substantial clinical and public health problem because it contributes to harmful effects on quality of life, daytime symptoms, road traffic incidents, and cardiometabolic disease. […] In the near future, the prognostic accuracy of these measures in predicting long term complications in obstructive sleep apnoea will likely be improved, together with better matching of treatments to disease subtypes. […] We believe that these factors might help us better understand the pathological basis of obstructive sleep apnoea and its complications, improve the prognosis for the long term effects on health, and better match patients to more specific treatments. […] Particular symptom subtypes were shown to be independent predictors of prevalent cardiovascular and cerebrovascular disease in moderate-to-severe obstructive sleep apnoea, and an increased risk of incident cardiovascular and cerebrovascular disease among patients with obstructive sleep apnoea (excessively sleepy subtype) was found.
  • #56
    https://link.springer.com/article/10.1007/s41060-018-0118-x
    In obstructive sleep apnea, respiratory effort is maintained but ventilation decreases/disappears due to upper-airway partial/total occlusion. This condition affects about 4% of men and 2% of women worldwide. […] The high (34%) proportion of normal results confirms the need for a pre-evaluation prior to polysomnography, making the search for a validated model to screen patients with suspicion of obstructive sleep apnea essential, especially at primary care level. […] In this clinical outcome, diagnostic models need to have a high sensitivity, as false negatives should be avoided, to prevent excluding patients with moderate or severe OSA from performing polysomnography (PSG), the standard test for OSA final diagnosis. […] This study is one of the first to build and validate risk models for OSA based solely on clinical and demographic variables, which have the key advantage of being easily available and quickly acquired.
  • #57
    https://link.springer.com/article/10.1007/s41060-018-0118-x
    In obstructive sleep apnea, respiratory effort is maintained but ventilation decreases/disappears due to upper-airway partial/total occlusion. This condition affects about 4% of men and 2% of women worldwide. […] The high (34%) proportion of normal results confirms the need for a pre-evaluation prior to polysomnography, making the search for a validated model to screen patients with suspicion of obstructive sleep apnea essential, especially at primary care level. […] In this clinical outcome, diagnostic models need to have a high sensitivity, as false negatives should be avoided, to prevent excluding patients with moderate or severe OSA from performing polysomnography (PSG), the standard test for OSA final diagnosis. […] This study is one of the first to build and validate risk models for OSA based solely on clinical and demographic variables, which have the key advantage of being easily available and quickly acquired.
  • #58
    https://link.springer.com/article/10.1007/s41060-018-0118-x
    We present as main risk factors: gender, age, neck circumference, and craniofacial and upper-airway abnormalities, and as diagnostic factors: witnessed apneas and nocturia. […] According to our cross-validated evaluation, we expected around 30% of false positives which, although unwanted, is nonetheless an improvement if we compare with all patients at risk being referred to sleep consultation and polysomnography. Nonetheless, we were able to rule out 25% of healthy patients, which, in our understanding, would alleviate health services by reducing the burden of unneeded consultations and the wait lists for polysomnography, while identifying more than 90% of patients with OSA.
  • #59
    https://link.springer.com/article/10.1007/s41060-018-0118-x
    We present as main risk factors: gender, age, neck circumference, and craniofacial and upper-airway abnormalities, and as diagnostic factors: witnessed apneas and nocturia. […] According to our cross-validated evaluation, we expected around 30% of false positives which, although unwanted, is nonetheless an improvement if we compare with all patients at risk being referred to sleep consultation and polysomnography. Nonetheless, we were able to rule out 25% of healthy patients, which, in our understanding, would alleviate health services by reducing the burden of unneeded consultations and the wait lists for polysomnography, while identifying more than 90% of patients with OSA.

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górne drogi oddechowe polisomnografia obturacyjny bezdech senny hipoksja terapia PAP hipoksemia nocna indeks AHI nadciśnienie tętnicze acetazolamid choroba wieńcowa stymulacja nerwu podjęzykowego udar mózgu senność dzienna fenotypowanie molekularne nokturia chrapanie zawał mięśnia sercowego saturacja tlenu miażdżyca terapia CPAP aparaty doustne funkcje poznawcze