BACKGROUND The "Baveno classification" replaced the apnoea hypopnoea index (AHI) with symptoms and comorbidities for treatment indication in obstructive sleep apnoea (OSA). This study evaluates a modified Baveno classification which adds a validated cardiovascular disease (CVD) risk score and acknowledges severe breathing disturbances. METHOD OSA patients from the European Sleep Apnoea Data Base (ESADA) were retrospectively allocated into CVD risk groups 1-3 based on SCORE-2 and the ESC guidelines. AHI ≥30 /h conferred strong treatment indication. When AHI was <30/h, symptoms and CVD risk dictated allocation to weak, intermediate or strong treatment indication group. Change in Epworth Sleepiness Scale (ESS) and office systolic blood pressure (SBP) at follow-up (12-24 months) under positive airway pressure (PAP) were assessed. RESULTS 8625 patients were analysed (29% female, age 56 [49;64] years, BMI 31.9 [28.4;36.3] kg·m-2). Treatment indication was weak in 501 (6%), intermediate in 2085 (24%) and strong in 6039 (70%). There was a continuous increase in age, SBP, C-reactive protein and glycosylated haemoglobin from weak to strong (p<0.001). PAP prescription increased from 52% to 64% to 93% (weak to strong, p<0.001). The change in ESS score was -2, -4 and -5, respectively (p<0.001). Reductions of ≥3 mmHg of median SBP occurred when AHI was ≥30/h and in symptomatic patients with CVD risk levels>1 when AHI was <30/h. CONCLUSION This analysis provides supporting evidence for the key role of CVD risk assessment and severe breathing disturbances in the identification of OSA patients most likely to benefit from treatment.

中文翻译：

---

阻塞性睡眠呼吸暂停的改良 Baveno 分类 - 基于 ESADA 数据库的开发和评估。


背景 “Baveno 分类”用阻塞性睡眠呼吸暂停 （OSA） 治疗指征的症状和合并症取代了呼吸暂停低通气指数 （AHI）。本研究评估了改良的 Baveno 分类，该分类增加了经过验证的心血管疾病 （CVD） 风险评分，并承认严重的呼吸障碍。方法 根据 SCORE-2 和 ESC 指南，将来自欧洲睡眠呼吸暂停数据库 （ESADA） 的 OSA 患者回顾性分配到 CVD 风险组 1-3。AHI ≥30 /h 具有较强的治疗指征。当 AHI 为 <30/h 时，症状和 CVD 风险决定了分配给弱、中或强治疗适应症组。在气道正压通气 （PAP） 下评估随访 （12-24 个月） 时 Epworth 嗜睡量表 （ESS） 和诊室收缩压 （SBP） 的变化。结果 分析了 8625 例患者 （29% 为女性，年龄 56 [49;64] 岁，BMI 31.9 [28.4;36.3] kg·m-2）。治疗适应症为 501 例 （6%） 较弱，2085 例为中等 （24%），6039 例为强 （70%）。年龄、 SBP 、 C 反应蛋白和糖化血红蛋白由弱到强持续增加 （p<0.001）。PAP 处方从 52% 增加到 64% 再到 93% （从弱到强，p<0.001）。ESS 评分变化分别为 -2 、 -4 和 -5 （p<0.001）。当 AHI 为 ≥30/h 时，中位 SBP 降低 ≥3 mmHg，当 AHI 为 <30/h 时，具有 CVD 风险水平 >1 的有症状患者。结论 该分析为 CVD 风险评估和严重呼吸障碍在识别最有可能从治疗中受益的 OSA 患者中的关键作用提供了支持证据。