Phenotyping Osas Patients Based On Comorbidities In The Primary Health Care In Greece

Obstructive sleep apnea syndrome (OSΑS) is a heterogeneous sleep disorder and an important public health issue. Epidemiological studies in the general population show that the prevalence is around 5%-10%. Our the was to define phenotypes of comorbidity in OSAS patients referred to the Primary Health Care (PHC) system. We enrolled 1496 patients who referred to PHC system for any respiratory or sleep related issue for the period between November 2015 and September 2017. A fraction of the study population underwent evaluation with polysomnography (PSG) in the Sleep Clinic of the interconnected General Hospital, in order to establish the OSAS diagnosis. 136 patients were included in the final statistical analysis. Quantification of the severity of the comorbidities was assessed using the Charlson Comorbidity index. Categorical Principal Component Analysis and two-step clustering were used to identify distinct clusters in the study population. Univariate comparisons between clusters were made by one-way ANOVA with post-hoc Bonferroni correction and chi-square tests. The analysis revealed three clusters. The first with moderate OSAS, obesity, and high ESS score without significantly comorbidities, the second with severe OSAS, severe obesity with comorbidities and the highest ESS score and the third with severe OSAS, obesity without comorbidities but with high ESS score. Clusters differed in age (p<0.005), body mass index, apnea-hypopnea index, oxygen desaturation index, arousal index, respiratory and desaturation arousal index (p<0.001). Predictive comorbidity models may aid the early diagnosis of patients at risk and pave the way for personalized treatment.