Obstructive Sleep Apnea With or Without Excessive Daytime Sleepiness: Clinical and Experimental Data-Driven Phenotyping
Articolo
Data di Pubblicazione:
2018
Citazione:
Garbarino, S., Scoditti, E., Lanteri, P., Conte, L., Magnavita, N., Toraldo, D. M., Obstructive Sleep Apnea With or Without Excessive Daytime Sleepiness: Clinical and Experimental Data-Driven Phenotyping, <>, 2018; 9 (505): N/A-N/A. [doi:10.3389/fneur.2018.00505] [http://hdl.handle.net/10807/123528]
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.
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.
Tipologia CRIS:
Articolo in rivista, Nota a sentenza
Keywords:
continuous positive airway pressure, excessive daytime sleepiness, hypoxia, obstructive sleep apnea, phenotype, sleep
Elenco autori:
Garbarino, Sergio; Scoditti, Egeria; Lanteri, Paola; Conte, Luana; Magnavita, Nicola; Toraldo, Domenico M.
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