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Sleep. 2018 Mar 1;41(3). doi: 10.1093/sleep/zsx214.

Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis.

Author information

Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.
School of Nursing, University of Pennsylvania, Philadelphia, PA.
Sir Charles Gairdner Hospital, Western Australian Sleep Disorders Research Institute, Nedlands, Western Australia, Australia.
Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Royal North Shore Hospital, Northern Clinical School, and Charles Perkins Centre University of Sydney, Australia.
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH.
Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany.
Department of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Germany.
Pulmonary, Critical Care and Sleep Disorder Center, Korea University Medical Center Ansan Hospital, Seoul, South Korea.


Study Objectives:

A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort.


Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes.


The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m2), and had severe OSA (42.0-51.4 events per hour) on average.


Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.

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