Impact of Desaturation Patterns versus Apnea–Hypopnea Index in the Development of Cardiovascular Comorbidities in Obstructive Sleep Apnea Patients

Figures & data

Table 1 OSA Phenotypes According to Demographics, Symptoms, PSG Pattern, CPAP Benefit and Comorbidities.^18,20,23,24

	A	B	C	D	E	F
	Classic	Oldest Comorbid	Female, Insomnia	Youngest, Upper Airways Symptoms	Severe Hypoxemic	Severe Non-Hypoxemic
Age	Younger	Oldest	Middle	Youngest	Younger	Older
Predominant sex	♂	♂	♀	♂	♂	♂
BMI	Obese	Obese	Overweight-Obese	Non Obese	Severely Obese	Obese
Symptoms	EDS	Naps	Insomnia	Choking + Insomnia	EDS	Less sleepy
PSG pattern
AHI	Severe	Severe	Moderate-Severe	Severe	Hypersevere	Severe
Time spent <90% Sa02	Medium	32–59%	Medium	10–15%	20–45%	<12%
Comorbidities	-	++	±	–	NA	NA
Benefit of CPAP	Highest	Lowest	Medium	Medium	High	Medium
Incidence CVD	+	-	NA	NA	+	NA

Abbreviations: BMI, body mass index; PSG, polysomnographic; SaO2, oxygen saturation; CPAP, continuous positive airway pressure; EDS, excessive daytime sleepiness; NA, not assessed; CVD, cardiovascular disease; ♂, male; ♀, female.

Figure 1 Illustration of the pathophysiological consequences of intermittent hypoxia in obstructive sleep apnea (OSA).

Abbreviations: CRP, C-reactive protein; eNOS, endothelial nitric oxide synthase; HIF, hypoxia-inducible factor; NADPH, nicotinamide adenine dinucleotide phosphate hydrogen; RNS, reactive nitrogen species; ROS, reactive oxygen species; SREBP1, sterol regulatory element-binding protein 1, SCD-1, stearoyl-CoA desaturase-1; TNF-α, tumor necrosis factor, VEGF; vascular epithelial growth factor.

Figure 2 Calculation of the “obstruction severity” and “desaturation severity” metrics as proposed by Kainulainen et al⁴².

Figure 3 Proposed 3-dimensional model that aims to assess 8 categories of OSA severity, considering Symptoms (excessive daytime sleepiness, ESS <11 or >11), comorbidities (presence/absence of end-stage organ injury or comorbidities) and severity factors on PSG (hypoxic burden below or >53% min/hour). The circle shows the 4 categories of highest severity. In this model, the equal distribution between each severity category has been chosen arbitrarily since the prevalence of each category is currently unknown.

Abbreviations: OSA, obstructive sleep apnea; ESS, Epworth Sleepiness Score; P(S)G, poly(somno)graphy.

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