TY - JOUR
T1 - Defining Extreme Phenotypes of OSA Across International Sleep Centers
AU - Rizzatti, Fabiola G.
AU - Mazzotti, Diego R.
AU - Mindel, Jesse
AU - Maislin, Greg
AU - Keenan, Brendan T.
AU - Bittencourt, Lia
AU - Chen, Ning Hung
AU - Cistulli, Peter A.
AU - McArdle, Nigel
AU - Pack, Frances M.
AU - Singh, Bhajan
AU - Sutherland, Kate
AU - Benediktsdottir, Bryndis
AU - Fietze, Ingo
AU - Gislason, Thorarinn
AU - Lim, Diane C.
AU - Penzel, Thomas
AU - Sanner, Bernd
AU - Han, Fang
AU - Li, Qing Yun
AU - Schwab, Richard
AU - Tufik, Sergio
AU - Pack, Allan I.
AU - Magalang, Ulysses J.
N1 - Publisher Copyright:
© 2020 American College of Chest Physicians
PY - 2020/9
Y1 - 2020/9
N2 - Background: Extreme phenotypes of OSA have not been systematically defined. Research Question: This study developed objective definitions of extreme phenotypes of OSA by using a multivariate approach. The utility of these definitions for identifying characteristics that confer predisposition toward or protection against OSA is shown in a new prospective sample. Study Design and Methods: In a large international sample, race-specific liability scores were calculated from a weighted logistic regression that included age, sex, and BMI. Extreme cases were defined as individuals with an apnea-hypopnea index (AHI) ≥ 30 events/hour but low likelihood of OSA based on age, sex, and BMI (liability scores > 90th percentile). Similarly, extreme controls were individuals with an AHI < 5 events/hour but high likelihood of OSA (liability scores < 10th percentile). Definitions were applied to a prospective sample from the Sleep Apnea Global Interdisciplinary Consortium, and differences in photography-based craniofacial and intraoral phenotypes were evaluated. Results: This study included retrospective data from 81,338 individuals. A total of 4,168 extreme cases and 1,432 extreme controls were identified by using liability scores. Extreme cases were younger (43.1 ± 14.7 years), overweight (28.6 ± 6.8 kg/m2), and predominantly female (71.1%). Extreme controls were older (53.8 ± 14.1 years), obese (34.0 ± 8.1 kg/m2), and predominantly male (65.8%). These objective definitions identified 29 extreme cases and 87 extreme controls among 1,424 Sleep Apnea Global Interdisciplinary Consortium participants with photography-based phenotyping. Comparisons suggest that a greater cervicomental angle increases risk for OSA in the absence of clinical risk factors, and smaller facial widths are protective in the presence of clinical risk factors. Interpretation: This objective definition can be applied in sleep centers throughout the world to consistently define OSA extreme phenotypes for future studies on genetic, anatomic, and physiologic pathways to OSA.
AB - Background: Extreme phenotypes of OSA have not been systematically defined. Research Question: This study developed objective definitions of extreme phenotypes of OSA by using a multivariate approach. The utility of these definitions for identifying characteristics that confer predisposition toward or protection against OSA is shown in a new prospective sample. Study Design and Methods: In a large international sample, race-specific liability scores were calculated from a weighted logistic regression that included age, sex, and BMI. Extreme cases were defined as individuals with an apnea-hypopnea index (AHI) ≥ 30 events/hour but low likelihood of OSA based on age, sex, and BMI (liability scores > 90th percentile). Similarly, extreme controls were individuals with an AHI < 5 events/hour but high likelihood of OSA (liability scores < 10th percentile). Definitions were applied to a prospective sample from the Sleep Apnea Global Interdisciplinary Consortium, and differences in photography-based craniofacial and intraoral phenotypes were evaluated. Results: This study included retrospective data from 81,338 individuals. A total of 4,168 extreme cases and 1,432 extreme controls were identified by using liability scores. Extreme cases were younger (43.1 ± 14.7 years), overweight (28.6 ± 6.8 kg/m2), and predominantly female (71.1%). Extreme controls were older (53.8 ± 14.1 years), obese (34.0 ± 8.1 kg/m2), and predominantly male (65.8%). These objective definitions identified 29 extreme cases and 87 extreme controls among 1,424 Sleep Apnea Global Interdisciplinary Consortium participants with photography-based phenotyping. Comparisons suggest that a greater cervicomental angle increases risk for OSA in the absence of clinical risk factors, and smaller facial widths are protective in the presence of clinical risk factors. Interpretation: This objective definition can be applied in sleep centers throughout the world to consistently define OSA extreme phenotypes for future studies on genetic, anatomic, and physiologic pathways to OSA.
KW - OSA
KW - extreme phenotype
KW - facial photographs
KW - liability score
UR - http://www.scopus.com/inward/record.url?scp=85089567700&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.03.055
DO - 10.1016/j.chest.2020.03.055
M3 - 文章
C2 - 32304773
AN - SCOPUS:85089567700
SN - 1931-3543
VL - 158
SP - 1187
EP - 1197
JO - Chest
JF - Chest
IS - 3
ER -