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    Recognizable clinical subtypes of obstructive sleep apnea across international sleep centers: a cluster analysis
    (Oxford Univ Press Inc, 2018) Keenan, Brendan T.; Kim, Jinyoung; Singh, Bhajan; Bittencourt, Lia [UNIFESP]; Chen, Ning-Hung; Cistulli, Peter A.; Magalang, Ulysses J.; McArdle, Nigel; Mindel, Jesse W.; Benediktsdottir, Bryndis; Arnardottir, Erna Sif; Prochnow, Lisa Kristin; Penzel, Thomas; Sanner, Bernd; Schwab, Richard J.; Shin, Chol; Sutherland, Kate; Tufik, Sergio [UNIFESP]; Maislin, Greg; Gislason, Thorarinn; Pack, Allan I.
    Study Objectives: A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods: Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] >= 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results: The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity