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Evaluation of a multicomponent grading system for obstructive sleep apnoea: the Baveno classification

Winfried J. Randerath, Simon Herkenrath, Marcel Treml, Ludger Grote, Jan Hedner, Maria Rosaria Bonsignore, Jean Louis Pépin, Silke Ryan, Sophia Schiza, Johan Verbraecken, Walter T. McNicholas, Athanasia Pataka, Pawel Sliwinski, Özen K. Basoglu
ERJ Open Research 2021 7: 00928-2020; DOI: 10.1183/23120541.00928-2020
Winfried J. Randerath
1Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
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  • ORCID record for Winfried J. Randerath
Simon Herkenrath
1Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
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Marcel Treml
1Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
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Ludger Grote
2Dept of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jan Hedner
2Dept of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Maria Rosaria Bonsignore
3PROMISE Dept, University of Palermo and CNR Institute of Biomedical Research and Innovation (IRIB), Palermo, Italy
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  • ORCID record for Maria Rosaria Bonsignore
Jean Louis Pépin
4HP2 Laboratory, INSERM U1042, Grenoble Alpes University and EFCR Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France
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Silke Ryan
5Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital and School of Medicine, University College Dublin, Dublin, Ireland
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Sophia Schiza
6Dept of Respiratory Medicine, Sleep Disorders Center, Medical School, University of Crete, Heraklion, Greece
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Johan Verbraecken
7Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Antwerp, Belgium
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Walter T. McNicholas
5Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital and School of Medicine, University College Dublin, Dublin, Ireland
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Athanasia Pataka
8Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
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Pawel Sliwinski
9Institute of Tuberculosis and Lung Diseases, 4th Dept of Respiratory Medicine, Warsaw, Poland
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Özen K. Basoglu
10Dept of Chest Diseases, Ege University School of Medicine, Izmir, Turkey
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  • FIGURE 1
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    FIGURE 1

    The revised version of the Baveno classification. Details about symptom and comorbidity criteria are provided in the supplementary material. ESS: Epworth Sleepiness Scale. Reproduced from Randerath et al. [30].

  • FIGURE 2
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    FIGURE 2

    Flow-chart of the inclusion process. ESADA: European Sleep Apnoea Database; PAP: positive airway pressure; PSG: polysomnography; PG: polygraphy; AHI: apnoea–hypopnoea index; SysBP: systolic blood pressure; DiaBP: diastolic blood pressure; CPAP: continuous positive airway pressure; APAP: automatic positive airway pressure.

  • FIGURE 3
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    FIGURE 3

    Distribution of the Baveno groups A–D in different apnoea–hypopnoea index (AHI) groups and in the overall patients.

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    FIGURE 4

    Changes in systolic and diastolic blood pressure (BP) between baseline and follow-up in the different Baveno groups A–D. Circles denote outlier values (>1.5 interquartile ranges outside the box), asterisks denote extreme values (>3 interquartile ranges outside the box). #: p<0.001 baseline versus follow-up.

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    FIGURE 5

    Change of the Epworth Sleepiness Scale (ESS) score between baseline and follow-up in the different Baveno groups A–D. Circles denote outlier values (>1.5 interquartile ranges outside the box). #: p<0.001 baseline versus follow-up.

  • FIGURE 6
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    FIGURE 6

    Percent of patients with positive airway pressure (PAP) prescription at baseline in the different apnoea–hypopnoea index (AHI) groups and in the whole study population. White columns represent actual PAP prescription as per conventional clinical routine decision; shaded columns represent PAP prescription as indicated by Baveno classification (i.e. Baveno groups B–D).

Tables

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  • TABLE 1

    Patient characteristics within the four Baveno groups A–D

    Group A (n=3447)Group B (n=2771)Group C (n=4482)Group D (n=3799)
    Females %28.128.127.827.8
    Age years54 (44; 62)***,¶,+52 (43; 60)***,¶57 (48; 65)***56 (47; 63)
    BMI kg·m−230.0 (26.9; 33.8)***,¶,+31.0 (27.4; 35.3)***,¶31.7 (28.1; 36.3)***33.6 (29.8; 38.3)
    Systolic BP mmHg125 (120; 130)***,¶125 (120; 130)***,¶140 (130; 150)140 (130; 150)
    Diastolic BP mmHg77 (70; 80)***,¶77 (70; 80)***,¶85 (78; 91)85 (79; 91)
    ESS#6 (4; 8)***,+14 (12; 16)¶6 (4; 8)***14 (12; 17)
    AHI events·h−127.0 (14.3; 44.3)***,¶,+31.5 (17.4; 53.5)***,¶28.2 (15.6; 49.8)***37.7 (19.5; 63.3)
    ODI events·h−122.8 (10.4; 42.0)***,¶,+27.4 (11.8; 51.5)***24.9 (11.9; 47.0)***35.0 (15.2; 61.9)
    Mean SpO2 %93.4 (92.0; 95.0)***,¶,+93.0 (91.0; 95.0)***93.0 (91.0; 94.8)***92.1 (90.0; 94.0)
    Minimum SpO2 %82 (77; 87)***,¶,+81 (74; 86)***81 (74; 86)***78 (70; 84)
    t90 min8.7 (1.0; 38.5)***,¶,+15.0 (1.9; 62.8)***13.0 (2.0; 59.0)***31.0 (4.9; 102.0)

    Data are presented as median (quartile 1; quartile 3) unless otherwise stated. BMI: body mass index; BP: blood pressure; ESS: Epworth Sleepiness Scale; AHI: apnoea–hypopnoea index; ODI: oxygen desaturation index; SpO2: oxygen saturation as measured by pulse oximetry; t90: percentage of sleep time with SpO2<90%. #: scale 0–24. ***: p<0.001 versus D; ¶: p<0.001 versus C; +: p<0.001 versus B.

    Supplementary Materials

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      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary material 00928-2020.SUPPLEMENT

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    Evaluation of a multicomponent grading system for obstructive sleep apnoea: the Baveno classification
    Winfried J. Randerath, Simon Herkenrath, Marcel Treml, Ludger Grote, Jan Hedner, Maria Rosaria Bonsignore, Jean Louis Pépin, Silke Ryan, Sophia Schiza, Johan Verbraecken, Walter T. McNicholas, Athanasia Pataka, Pawel Sliwinski, Özen K. Basoglu
    ERJ Open Research Jan 2021, 7 (1) 00928-2020; DOI: 10.1183/23120541.00928-2020

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    Evaluation of a multicomponent grading system for obstructive sleep apnoea: the Baveno classification
    Winfried J. Randerath, Simon Herkenrath, Marcel Treml, Ludger Grote, Jan Hedner, Maria Rosaria Bonsignore, Jean Louis Pépin, Silke Ryan, Sophia Schiza, Johan Verbraecken, Walter T. McNicholas, Athanasia Pataka, Pawel Sliwinski, Özen K. Basoglu
    ERJ Open Research Jan 2021, 7 (1) 00928-2020; DOI: 10.1183/23120541.00928-2020
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