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PLoS One. 2016 Oct 4;11(10):e0163439. doi: 10.1371/journal.pone.0163439. eCollection 2016.

Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients.

Author information

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.
Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland.
Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy.
CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Department of Respiratory and Sleep Medicine, St. Vincent´s University Hospital, Dublin, Ireland.
Conway Research Institute, University College Dublin, Dublin, Ireland.
Schlafmedizinisches Zentrum, Charité -Universitätsmedizin Berlin, Berlin, Germany.
International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
Department of ENT, Førde Central Hospital, Førde, Norway.
Centre for Sleep and Waking Disorders, Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
Inspamed, Neurology and Sleep Laboratory, Prague, Czech Republic.
Institute of Tuberculosis and Lung Diseases, 4th Department of Respiratory Medicine, Warsaw, Poland.
Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium.
University of Antwerp, Antwerp, Belgium.



Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established.


A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/non-insomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype.


The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188-1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity.


Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS.

[Indexed for MEDLINE]
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Conflict of interest statement

Competing Interests: JH reports that the ESADA database has received two enabling grants from ResMed and Philips Respironics and a Clinical Reseach Cooperation (CRC) grant from the European Respiratory Society. LG reports grants, personal fees and other from Resmed, grants, personal fees and non-financial support from Philips and Weinmann, personal fees from Breas and Mundipharma as well as non-financial support from Itamar, outside the submitted work. TP reports grants from ImThera, grants from Itamar, Heinen and Löwenstein, Resmed and from Philips / Respironics, outside the submitted work. TS reports grants from Paulo Foundation, grants from Governmental Grant of Turku University Hospital, grants from Finnish Anti-Tuberculosis Association Foundation, grants from Respiratory Alliance Foundation, grants from Väinö and Laina Kivi Foundation, grants from Ahokas Foundation, during the conduct of the study. MRB, RLR, WTMcN, UA, JAK, MP, PS, and JV have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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