Evaluation of a multicomponent grading system (Baveno classification) for obstructive sleep apnoea
- Winfried J. Randerath1⇑,
- Simon Herkenrath1,
- Marcel Treml1,
- Ludger Grote2,
- Jan Hedner2,
- Maria Rosaria Bonsignore3,
- Jean Louis Pépin4,
- Silke Ryan5,
- Sophia Schiza6,
- Johan Verbraecken7,
- Walter T. McNicholas5,
- Athanasia Pataka8,
- Pawel Sliwinski9 and
- Özen K. Basoglu10
- 1Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany
- 2Department of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- 3PROMISE Department, University of Palermo and CNR Institute of Biomedical Research and Innovation (IRIB), Palermo, Italy
- 4HP2 Laboratory, INSERM U1042, Grenoble Alpes University and EFCR Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France
- 5Department of Respiratory and Sleep Medicine, St Vincent's University Hospital and School of Medicine, University College Dublin, Dublin, Ireland
- 6Department of Respiratory Medicine, Sleep Disorders Center, Medical School, University of Crete, Heraklion, Greece
- 7Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Antwerp, Belgium
- 8Respiratory Failure Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
- 9Institute of Tuberculosis and Lung Diseases, 4th Department of Respiratory Medicine, Warsaw, Poland
- 10Department of Chest Diseases, Ege University School of Medicine, Izmir, Turkey
- Winfried J. Randerath, MD, Prof. of Medicine, FATS, FCCP, Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care - Solingen (Germany). Aufderhöherstraße 169, 42699 Solingen, Germany. E-mail: randerath{at}klinik-bethanien.de
Abstract
New findings on pathophysiology, epidemiology, and outcome have raised concerns on the relevance of the apnoea-hypopnoea index (AHI) in the classification of obstructive sleep apnoea (OSA) severity. Recently, a multicomponent grading system, decision integrating symptomatology and comorbidities (Baveno classification), was proposed to characterise OSA and to guide therapeutic decisions. We evaluated if this system reflects the OSA population, if it translates into differences in outcomes, and if the addition of AHI improves the scheme. 14 499 OSA patients from the European Sleep Apnoea Database (ESADA) cohort were analysed. The groups were homogeneously distributed and were found to clearly stratify the population with respect to baseline parameters. Differences in sleepiness and blood pressure between the groups were analysed in a subgroup of patients after 24–36 months of treatment. Group A (minor symptoms and comorbidities) did not demonstrate any effect of treatment on outcome. However, groups B (severe symptoms, minor comorbidities), C (minor symptoms, severe comorbidities) and D (severe symptoms and comorbidities) were associated with improvement in either or both parameters with treatment. The AHI is an essential prerequisite of the diagnosis. However, adding the AHI did not improve the classification. Rather, it was inferior with respect to guiding the treatment decision. Thus, the Baveno classification allows a better stratification of the OSA population and may provide a better guidance for therapeutic decisions in OSA.
Footnotes
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Conflict of interest: W.J. Randerath reports speaking fees and travel grants from Philips Respironics, Heinen und Löwenstein, Resmed, Bioprojet, Bayer Vital and Vanda Pharma outside the submitted work.
Conflict of interest: Dr. Herkenrath has nothing to disclose.
Conflict of interest: Dr. Treml has nothing to disclose.
Conflict of interest: Dr. Grote reports grants from Bayer, Philips Respironics Foundation, Resmed Foundation for the ESADA network during the conduct of the study; non-financial support and other from Itamar Medical, Resmed, Philips, Astra Zeneca, Breas outside the submitted work; In addition. Dr. Grote has a patent on sleep apnea therapy licensed.
Conflict of interest: Dr. Hedner reports grants from Bayer AG, the European Respiratory Society for Database maintenence and grants from Desitin GmbH, outside the submitted work; In addition, Dr. Hedner has a patent issued on pharmacological therapy of OSA.
Conflict of interest: Dr. BONSIGNORE has nothing to disclose.
Conflict of interest: Dr. Pépin reports and Grants and research funds from.
Conflict of interest: Dr. Ryan has nothing to disclose.
Conflict of interest: Dr. Schiza has nothing to disclose.
Conflict of interest: J. Verbraecken reports an educational grant and an advisory board fee from ResMed; a consultancy fee from Philips; lecture fees from Sanofi and Agfa-Gevaert; an educational grant and an advisory board fee from Bioprojet; an educational grant from and study participation for Jazz Pharmaceutics; an educational grant from AirLiquide; a lecture fee from Springer; an educational grant from Westfalen Medical; an educational grant and a lecture fee from SomnoMed; educational grants from Vivisol, Total Care, Medidis, Fisher & Paykel, Wave Medical, OSG, Mediq Tefa, NightBalance and Heinen & Löwenstein; lecture fees from AstraZeneca; and educational grants from Accuramed, Bekaert Deslee Academy and UCB Pharma, all outside the submitted work.
Conflict of interest: Dr. McNicholas has nothing to disclose.
Conflict of interest: Dr. Pataka has nothing to disclose.
Conflict of interest: Dr. Sliwinski has nothing to disclose.
Conflict of interest: Dr. Basoglu has nothing to disclose.
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- Received December 10, 2020.
- Accepted December 22, 2020.
- ©The authors 2021
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