title: Clinical Phenotypes and Comorbidity in European Sleep Apnoea Patients.
abstract: BACKGROUND
  Clinical presentation phenotypes of obstructive sleep apnoea (OSA) and their association with comorbidity as well as impact on adherence to continuous positive airway pressure (CPAP) treatment have not been established.
  
  
  METHODS
  A prospective follow-up cohort of adult patients with OSA (apnoea-hypopnoea index (AHI) of ≥5/h) from 17 European countries and Israel (n = 6,555) was divided into four clinical presentation phenotypes based on daytime symptoms labelled as excessive daytime sleepiness ("EDS") and nocturnal sleep problems other than OSA (labelled as "insomnia"): 1) EDS (daytime+/nighttime-), 2) EDS/insomnia (daytime+/nighttime+), 3) non-EDS/non-insomnia (daytime-/nighttime-), 4) and insomnia (daytime-/nighttime+) phenotype.
  
  
  RESULTS
  The EDS phenotype comprised 20.7%, the non-EDS/non-insomnia type 25.8%, the EDS/insomnia type 23.7%, and the insomnia phenotype 29.8% of the entire cohort. Thus, clinical presentation phenotypes with insomnia symptoms were dominant with 53.5%, but only 5.6% had physician diagnosed insomnia. Cardiovascular comorbidity was less prevalent in the EDS and most common in the insomnia phenotype (48.9% vs. 56.8%, p<0.001) despite more severe OSA in the EDS group (AHI 35.0±25.5/h vs. 27.9±22.5/h, p<0.001, respectively). Psychiatric comorbidity was associated with insomnia like OSA phenotypes independent of age, gender and body mass index (HR 1.5 (1.188-1.905), p<0.001). The EDS phenotype tended to associate with higher CPAP usage (22.7 min/d, p = 0.069) when controlled for age, gender, BMI and sleep apnoea severity.
  
  
  CONCLUSIONS
  Phenotypes with insomnia symptoms comprised more than half of OSA patients and were more frequently linked with comorbidity than those with EDS, despite less severe OSA. CPAP usage was slightly higher in phenotypes with EDS.
authors.affiliation: Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.|Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Saaresranta
authors.affiliation: Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.|Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hedner
authors.affiliation: Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy.|CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy.
authors.forename: Maria R
authors.initials: MR
authors.lastname: Bonsignore
authors.affiliation: Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Renata L
authors.initials: RL
authors.lastname: Riha
authors.affiliation: Department of Respiratory and Sleep Medicine, St. Vincent´s University Hospital, Dublin, Ireland.|Conway Research Institute, University College Dublin, Dublin, Ireland.
authors.forename: Walter T
authors.initials: WT
authors.lastname: McNicholas
authors.affiliation: Schlafmedizinisches Zentrum, Charité -Universitätsmedizin Berlin, Berlin, Germany.|International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
authors.forename: Thomas
authors.initials: T
authors.lastname: Penzel
authors.affiliation: Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.|Sleep Research Centre, Department of Physiology, University of Turku, Turku, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Anttalainen
authors.affiliation: Department of ENT, Førde Central Hospital, Førde, Norway.
authors.forename: John Arthur
authors.initials: JA
authors.lastname: Kvamme
authors.affiliation: Centre for Sleep and Waking Disorders, Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic.|Inspamed, Neurology and Sleep Laboratory, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Pretl
authors.affiliation: Institute of Tuberculosis and Lung Diseases, 4th Department of Respiratory Medicine, Warsaw, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Sliwinski
authors.affiliation: Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium.|University of Antwerp, Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Verbraecken
authors.affiliation: Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.|Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Ludger
authors.initials: L
authors.lastname: Grote
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000453:epidemiology*; D044465:White People; D055815:Young Adult