Beyond the Apnoea–Hypopnoea Index: Towards Personalised Care of Patients with Suspected Obstructive Sleep Apnoea Through Clinical Phenotyping and Physiological Stratification
6 affiliations
- 1NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
- 2Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- 3School of Industrial Engineering, University of Vigo, 36310 Vigo, Spain
- 4Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain
- 5Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
- 6Department of Functional Biology and Health Sciences, University of Vigo, 36310 Vigo, Spain
Abstract
The apnoea–hypopnoea index (AHI) remains central to the diagnosis of obstructive sleep apnoea (OSA), but it incompletely captures both clinical heterogeneity and the physiological burden of respiratory events. We propose a phenotype-guided framework with a common initial clinical assessment followed by two complementary pathways according to the patient’s predominant clinical need: a symptom-oriented pathway based on pre-test clinical phenotyping, and a cardiovascular risk-oriented pathway in which directly measured hypoxic burden (HB), complemented by the respiratory event-related pulse-rate response, may eventually support physiological stratification. In our single-centre cohort of 5385 referrals, three predominantly symptomatic phenotypes accounted for 56.5% of patients and two paucisymptomatic phenotypes (A and E) for 43.5%; these groups had overlapping AHI distributions but different clinical profiles and needs. The reported AUC of 0.87–0.95 reflects supervised reproduction of internally derived cluster labels, not prediction of clinical outcomes or CPAP benefit. HB and pulse-rate response remain candidate physiological markers: evidence for treatment-effect modification derives from post hoc analyses and does not establish validated treatment-allocation criteria. Pre-test phenotyping is sufficiently developed to justify prospective, external, multicentre validation, whereas physiological integration requires methodological standardisation and prospective evaluation before individual treatment decisions can be guided by these markers.
Related
- Personalised normative cardiac phenotyping reveals clinically relevant heterogeneity in cardiac shape and outcome risk
- Beyond the Apnea-Hypopnea Index: Cardiovascular and Metabolic Phenotyping of Hypertensive Patients with Obstructive Sleep Apnea—A Narrative Review
- The sound of snoring: AI-based acoustic phenotyping of upper airway obstruction in Obstructive Sleep Apnea
- When Hydronephrosis Was Not Physiological: A Case of Septic Shock Secondary to Obstructive Uropathy in Pregnancy
- Artificial Intelligence-Derived Computed Tomography Phenotyping for Cardiovascular Risk Stratification in Transcatheter Mitral Valve Replacement.
BibTeX
@article{mosteiroanon2026beyond,
title = {{Beyond the Apnoea–Hypopnoea Index: Towards Personalised Care of Patients with Suspected Obstructive Sleep Apnoea Through Clinical Phenotyping and Physiological Stratification}},
author = {Mar Mosteiro-Añón and Manuel Casal-Guisande and Alberto Fernández-Villar and María Torres-Durán},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208040},
url = {https://www.mdpi.com/2077-0383/15/20/8040},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beyond the Apnoea–Hypopnoea Index: Towards Personalised Care of Patients with Suspected Obstructive Sleep Apnoea Through Clinical Phenotyping and Physiological Stratification
AU - Mar Mosteiro-Añón
AU - Manuel Casal-Guisande
AU - Alberto Fernández-Villar
AU - María Torres-Durán
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208040
UR - https://www.mdpi.com/2077-0383/15/20/8040
AB - The apnoea–hypopnoea index (AHI) remains central to the diagnosis of obstructive sleep apnoea (OSA), but it incompletely captures both clinical heterogeneity and the physiological burden of respiratory events. We propose a phenotype-guided framework with a common initial clinical assessment followed by two complementary pathways according to the patient’s predominant clinical need: a symptom-oriented pathway based on pre-test clinical phenotyping, and a cardiovascular risk-oriented pathway in which directly measured hypoxic burden (HB), complemented by the respiratory event-related pulse-rate response, may eventually support physiological stratification. In our single-centre cohort of 5385 referrals, three predominantly symptomatic phenotypes accounted for 56.5% of patients and two paucisymptomatic phenotypes (A and E) for 43.5%; these groups had overlapping AHI distributions but different clinical profiles and needs. The reported AUC of 0.87–0.95 reflects supervised reproduction of internally derived cluster labels, not prediction of clinical outcomes or CPAP benefit. HB and pulse-rate response remain candidate physiological markers: evidence for treatment-effect modification derives from post hoc analyses and does not establish validated treatment-allocation criteria. Pre-test phenotyping is sufficiently developed to justify prospective, external, multicentre validation, whereas physiological integration requires methodological standardisation and prospective evaluation before individual treatment decisions can be guided by these markers.
SN - 2077-0383
ER -