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Multi-perspective clustering of obstructive sleep apnea towards precision therapeutic decision including craniofacial intervention

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Previous studies focusing on phenotyping obstructive sleep apnea (OSA) have outlined its heterogeneity in clinical symptoms, comorbidities, and polysomnographic features. However, the role of anatomical or pathophysiological causality including craniofacial skeletal deformity has not been studied. We aimed to identify and characterize phenotypes of OSA based on multi-perspective clustering by incorporating craniofacial risks with obesity, apnea severity, arousability, symptom, and comorbidity.

Methods

A total of 421 Korean patients with OSA (apnea-hypopnea index, AHI ≥ 5; age ≥ 20 years old) were recruited. A K-means cluster analysis was performed following principal component analysis with sagittal and vertical skeletal variables (ANB and mandibular plane angle), AHI, body mass index, and Epworth sleepiness scale. Inter-cluster comparison was conducted using demographic, cephalometric, and polysomnographic variables in addition to presence of diabetes and hypertension. Risk factors contributing to OSA severity were evaluated in each cluster using multivariable regression analysis with adjustment for age and gender.

Results

Three phenotypic clusters were identified and characterized as follows: Cluster-1 (noncraniofacial phenotype, 39%), non-obese moderate-to-severe OSA with no skeletal discrepancy representing low arousal threshold (ArTh), little sleepiness, and low comorbidity; Cluster-2 (craniofacial skeletal phenotype, 33%), non-obese moderate OSA with definite skeletal discrepancy showing low ArTh, mild sleepiness, and low comorbidity; and Cluster-3 (complicated phenotype, 28%), obese severe OSA with skeletal discrepancy exhibiting high ArTh, excessive daytime sleepiness, and high incidence of hypertension.

Conclusions

The three OSA phenotypes from multi-perspective clustering may provide a basis for precise therapeutic decision-making including craniofacial skeletal intervention beyond usual characterization of OSA subgroups.

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Acknowledgments

The authors have no commercial interests related to the subject of the study, and the study did not receive any commercial financial or material support.

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Authors and Affiliations

  1. Department of Orthodontics, School of Dentistry, Kyung Hee University, Seoul, South Korea

    Su-Jung Kim & Kyung-A Kim

  2. Department of Orthodontics, Kyung Hee University Dental Hospital, Seoul, South Korea

    Waleed Maqbul Alnakhli & Ali Saeed Alfaraj

  3. Department of Otorhinolaryngology, School of Medicine, Kyung Hee University, Seoul, South Korea

    Sung-Wan Kim

  4. Division of Sleep Surgery, Department of Otolaryngology, Stanford University school of Medicine, Stanford, CA, USA

    Stanley Yung-Chuan Liu

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  1. Su-Jung Kim
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  2. Waleed Maqbul Alnakhli
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  5. Sung-Wan Kim
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Correspondence to Su-Jung Kim.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board of Kyung Hee University Dental Hospital (KHD IRB 1811-2) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This was a retrospective study based on records, and formal consent was not required.

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Kim, SJ., Alnakhli, W.M., Alfaraj, A.S. et al. Multi-perspective clustering of obstructive sleep apnea towards precision therapeutic decision including craniofacial intervention. Sleep Breath 25, 85–94 (2021). https://doi.org/10.1007/s11325-020-02062-9

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  • DOI: https://doi.org/10.1007/s11325-020-02062-9

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