Obstructive sleep apnea with or without excessive daytime sleepiness: Clinical and experimental data-driven phenotyping

Sergio Garbarino, Egeria Scoditti, Paola Lanteri, Luana Conte, Nicola Magnavita, Domenico M. Toraldo

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common-but not universal-accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients. Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed. Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas. Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment. The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient's specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA.

Original languageEnglish
Article number505
JournalFrontiers in Neurology
Volume9
Issue numberJUN
DOIs
Publication statusPublished - Jun 27 2018

Fingerprint

Obstructive Sleep Apnea
Cardiovascular Diseases
Therapeutics
Continuous Positive Airway Pressure
Sleep Deprivation
Health
Apnea
PubMed
Epigenomics
Insulin Resistance
Consensus
Sleep
Body Mass Index
Economics
Pathology
Blood Pressure
Phenotype
Safety
Mortality
Research

Keywords

  • continuous positive airway pressure
  • Excessive daytime sleepiness
  • Hypoxia
  • Leep
  • Obstructive sleep apnea
  • Phenotype

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Obstructive sleep apnea with or without excessive daytime sleepiness : Clinical and experimental data-driven phenotyping. / Garbarino, Sergio; Scoditti, Egeria; Lanteri, Paola; Conte, Luana; Magnavita, Nicola; Toraldo, Domenico M.

In: Frontiers in Neurology, Vol. 9, No. JUN, 505, 27.06.2018.

Research output: Contribution to journalArticle

Garbarino, Sergio ; Scoditti, Egeria ; Lanteri, Paola ; Conte, Luana ; Magnavita, Nicola ; Toraldo, Domenico M. / Obstructive sleep apnea with or without excessive daytime sleepiness : Clinical and experimental data-driven phenotyping. In: Frontiers in Neurology. 2018 ; Vol. 9, No. JUN.
@article{d823690730d9460ab6edb28c9467a4ed,
title = "Obstructive sleep apnea with or without excessive daytime sleepiness: Clinical and experimental data-driven phenotyping",
abstract = "Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common-but not universal-accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients. Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed. Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas. Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment. The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient's specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA.",
keywords = "continuous positive airway pressure, Excessive daytime sleepiness, Hypoxia, Leep, Obstructive sleep apnea, Phenotype",
author = "Sergio Garbarino and Egeria Scoditti and Paola Lanteri and Luana Conte and Nicola Magnavita and Toraldo, {Domenico M.}",
year = "2018",
month = "6",
day = "27",
doi = "10.3389/fneur.2018.00505",
language = "English",
volume = "9",
journal = "Frontiers in Neurology",
issn = "1664-2295",
publisher = "Frontiers Research Foundation",
number = "JUN",

}

TY - JOUR

T1 - Obstructive sleep apnea with or without excessive daytime sleepiness

T2 - Clinical and experimental data-driven phenotyping

AU - Garbarino, Sergio

AU - Scoditti, Egeria

AU - Lanteri, Paola

AU - Conte, Luana

AU - Magnavita, Nicola

AU - Toraldo, Domenico M.

PY - 2018/6/27

Y1 - 2018/6/27

N2 - Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common-but not universal-accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients. Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed. Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas. Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment. The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient's specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA.

AB - Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common-but not universal-accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients. Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed. Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas. Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment. The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient's specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA.

KW - continuous positive airway pressure

KW - Excessive daytime sleepiness

KW - Hypoxia

KW - Leep

KW - Obstructive sleep apnea

KW - Phenotype

UR - http://www.scopus.com/inward/record.url?scp=85049076457&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049076457&partnerID=8YFLogxK

U2 - 10.3389/fneur.2018.00505

DO - 10.3389/fneur.2018.00505

M3 - Article

AN - SCOPUS:85049076457

VL - 9

JO - Frontiers in Neurology

JF - Frontiers in Neurology

SN - 1664-2295

IS - JUN

M1 - 505

ER -