Clinical Phenotyping Of OSAHS Based On Excessive Daytime Sleepiness,Age,Gender,and Smoking History

Part Ⅰ Clinical characteristics and contributing factors of excessive daytime sleepiness in patients with OSAHSObjective:Excessive daytime sleepiness(EDS)is a common symptom of obstructive sleep apnea-hypopnea syndrome(OSAHS);however,the severity of EDS varies greatly from patient to patient.In this study,we compared the clinical characteristics of OSAHS patients with different degrees of EDS,analyzed the relationship between EDS and other symptoms,comorbidities,and polysomnographic results,and explored possible contributing factors of EDS.Methods:Patients who underwent overnight polysomnography(PSG)in our hospital from January 2015 to June 2018 were screened consecutively,and a total of 874 patients with newly diagnosed OSAHS were enrolled.The sociodemographic features,symptoms,Epworth sleepiness scores(ESS),signs,comorbidities,and PSG outcomes were recorded.All patients were divided into three groups according to the ESS and there were 582 patients in the non-EDS group(ESS≤10),227 patients in the mild to moderate EDS group(11≤ESS≤16),and 65 patients in the severe EDS group(ESS≥17),respectively.The clinical characteristics were compared between groups,and the independent contributing factors of different degrees of EDS were explored.Results:The proportions of nocturnal wakefulness,dry mouth,memory loss and irritability were higher in the severe EDS and mild to moderate EDS groups than that of the non-EDS group.The proportions of morning headache,quality of life affected,work affected and traffic affected were the highest in severe EDS group,followed by mild to moderate EDS group,and lowest in non-EDS group.The proportion of nocturia was higher in severe EDS group than that of mild to moderate EDS group and non-EDS group.The proportions of pharyngeal stenosis and type 2 diabetes mellitus were higher in severe EDS group and mild to moderate EDS group than that of non-EDS group.The sleep efficiency,proportions of N1 sleep,micro-arousal index(MAI),apnea hypopnea index(AHI),maximum apnea time,and the percentage of sleep time with oxygen saturation less than 90%(SIT90)of the severe EDS group and mild to moderate EDS group were all higher than those of the non-EDS group,and the proportions of REM sleep,the nocturnal nadir and mean blood oxygen saturation were all lower than those of the non-EDS group.Multivariate regression analysis showed MAI(OR 1.010,95%CI 1.001-1.020),AHI(OR 1.021,95%CI 1.012-1.029),and SIT90(OR 1.010,95%CI 1.001-1.019)were independent contributing factors for mild to moderate EDS and AHI(OR 1.020,95%CI 1.002-1.039)and nocturnal mean oxygen saturation(OR 0.899,95%CI 0.812-0.996)were independent contributing factors for severe EDS.Conclusions:OSAHS patients with EDS have more symptoms and signs than those without EDS,a higher proportion of comorbid type 2 diabetes mellitus,more significant sleep structure disruption,more frequent respiratory events,and more severe nocturnal hypoxia.Sleep fragmentation,AHI and nocturnal hypoxia are all independent risk factors of EDS.Part Ⅱ Clinical phenotyping of OSAHS based on age and gender and study on the features of elderly and/or female patientsObjective:The prevalence of OSAHS increased with age.However,in the elderly,OSAHS is always underdiagnosed and studies on their characteristics are limited.The features of female patients are not well acquainted due to the low visiting rate in this population.In this study,the clinical manifestations,comorbidities,and polysomnographic results were compared between patients with different age and gender groups and the possible clinical phenotypic characteristics of elderly and/or female patients with OSAHS were explored.Methods:We screened 1274 patients who underwent overnight PSG in our hospital due to suspected OSAHS from January 2017 to December 2020,and finally 1108 adult patients with newly diagnosed OSAHS were enrolled.According to the age,all patients were divided into to two groups,with 70 cases in the elderly group(≥65 years old)and 1038 cases in the non-elderly group.Meanwhile,all patients were grouped by gender,with 936 cases in the male group and 172 cases in the female group.The clinical manifestations,comorbidities and polysomnographic results of different age and gender groups were compared.Multivariate analysis was used to explore the possible independent relationship between elderly/female and other OSAHS characteristics.Results:Nocturia was more common in elderly patients.The prevalence of comorbid hypertension,coronary artery disease,chronic obstructive pulmonary disease and ischemic stroke were significantly higher in the elderly.Age≥65 is an independent risk factor for comorbid hypertension(OR1.82,95%CI 1.03-3.19),coronary artery disease(OR 4.47,95%CI 2.33-8.57)and ischemic stroke(OR 3.17,95%CI 1.07-9.38)in OSAHS.The elderly patients had lower sleep efficiency,longer wake after sleep onset,more N1 sleep and less N2 and N3 sleep.The mean age of female patients was higher and most of them are perimenopausal.Nocturnal wakening and nocturia were more frequent in female patients,while ESS score was lower.The prevalence of hypothyroidism was higher in the females,and the female gender was an independent risk factor for comorbid hypothyroidism(OR 4.19,95%CI 1.90-9.24)in OSAHS.Female patients had lower sleep efficiency,longer wake after sleep onset,less N1 sleep,more N3 sleep,lower micro-arousal index and AHI.The maximum apnea time,oxygen desaturation index,and percentage of sleep time with oxygen saturation less than 90%were all lower in the female patients.Conclusions:In the elderly OSAHS,nocturia is more common,sleep fragmentation is more significant and there is an increased risk of comorbid hypertension,coronary artery disease and ischemic stroke.Female patients had a higher age,decreased AHI and less oxygen desaturation,and an increased risk of comorbid hypothyroidism.Both elderly or female OSAHS can be considered unique clinical phenotypes due to their particularity.Part Ⅲ Study on the relationship between smoking history and comorbidities in patients with OSAHSObjective:Smoking is also a common risk factor for many comorbidities of OSAHS.However,the correlation between smoking and the comorbidities in patients with OSAHS is still unclear.In this study,we evaluated the smoking history in newly diagnosed OSAHS patients,analyzed the relationship between smoking history and comorbidities,and discussed the clinical characteristics of OSAHS patients with smoking history.Methods:Newly diagnosed adult patients with OSAHS in our hospital from January 2016 to December 2019 were analyzed retrospectively.All patients underwent overnight polysomnography for the confirmation of OSAHS.According to the smoking history,all patients were divided into non-smoking group and current/former-smoking group.The sociodemographic characteristics,OSAHS related symptoms,signs,comorbidities,and polysomnographic results were compared between the two groups.The correlations between smoking history and comorbidities were analyzed.Results:A total of 1021 OSAHS patients were enrolled in this study,22%of whom were current/former smokers.The comparison between the two groups showed a higher proportion of male and elderly patients,a greater mean age,a higher ESS score,a longer sleep latency time and a lower nocturnal mean oxygen saturation in the current/former-smoking group.There was no significant difference in AHI between the two groups.OSAHS patients with a smoking history had increased prevalence of hypertension,coronary artery disease,chronic obstructive pulmonary disease,gastroesophageal reflux disease and chronic pharyngitis.Multivariate analysis showed smoking history was independently associated with hypertension(OR 2.09,95%CI:1.46-3.01),chronic obstructive pulmonary disease(OR 9.80,95%CI:4.73-20.33),gastroesophageal reflux disease(OR 1.97,95%CI:1.19-3.27)and chronic pharyngitis(OR 1.83,95%CI:1.32-2.54)in OSAHS patients.Conclusions:In this cohort of newly diagnosed OSAHS,there was no significant correlation between smoking history and AHI.However,smoking history significantly increased the burden of comorbidities associated with OSAHS.OSAHS patients with smoking history have increased risk of hypertension,chronic obstructive pulmonary disease,gastroesophageal reflux disease and chronic pharyngitis.