Evaluation of a multicomponent grading system for obstructive sleep apnoea: the Baveno classification.

New findings on pathophysiology, epidemiology, and outcome have raised concerns on the relevance of the apnoea-hypopnoea index (AHI) in the classification of obstructive sleep apnoea (OSA) severity. Recently, a multicomponent grading system decision integrating symptomatology and comorbidities (Baveno classification), was proposed to characterise OSA and to guide therapeutic decisions. We evaluated whether this system reflects the OSA population, whether it translates into differences in outcomes, and whether the addition of AHI improves the scheme. A total of 14 499 OSA patients from the European Sleep Apnoea Database cohort were analysed. The groups were homogeneously distributed and were found to clearly stratify the population with respect to baseline parameters. Differences in sleepiness and blood pressure between the groups were analysed in a subgroup of patients after 24-36 months of treatment. Group A (minor symptoms and comorbidities) did not demonstrate any effect of treatment on outcome. However, groups B (severe symptoms, minor comorbidities), C (minor symptoms, severe comorbidities) and D (severe symptoms and comorbidities) were associated with improvement in either or both parameters with treatment. The AHI is an essential prerequisite of the diagnosis; however, adding the AHI did not improve the classification. Rather, it was inferior with respect to guiding the treatment decision. Thus, the Baveno classification allows a better stratification of the OSA population and may provide a better guidance for therapeutic decisions in OSA.
Competing Interests: Conflict of interest: W.J. Randerath reports speaking fees and travel grants from Philips Respironics, Heinen und Löwenstein, ResMed, Bioprojet, Bayer Vital and Vanda Pharma outside the submitted work. Conflict of interest: S. Herkenrath has nothing to disclose. Conflict of interest: M. Treml has nothing to disclose. Conflict of interest: L. Grote reports grants from Bayer, the Philips Respironics Foundation and the ResMed Foundation for the ESADA network during the conduct of the study; and nonfinancial and other support from Itamar Medical, ResMed, Philips, AstraZeneca and Breas outside the submitted work. In addition, L. Grote has a patent on sleep apnoea therapy licensed. Conflict of interest: J. Hedner reports grants from Bayer AG, the European Respiratory Society (for database maintenance) and Desitin GmbH outside the submitted work; in addition, J. Hedner has a patent issued on pharmacological therapy of OSA. Conflict of interest: M.R. Bonsignore has nothing to disclose. Conflict of interest: J.L. Pépin grants and research funds from the Air Liquide Foundation, Agiradom, AstraZeneca, Fisher and Paykel, Mutualia, Philips, ResMed, and Vitalaire; and fees from Agiradom, AstraZeneca, Boehringer Ingelheim, Jazz Pharmaceutical, Night Balance, Philips and ResMed. Conflict of interest: S. Ryan has nothing to disclose. Conflict of interest: S. Schiza has nothing to disclose. Conflict of interest: J. Verbraecken reports an educational grant and an advisory board fee from ResMed; a consultancy fee from Philips; lecture fees from Sanofi and Agfa-Gevaert; an educational grant and an advisory board fee from Bioprojet; an educational grant from and study participation for Jazz Pharmaceutics; an educational grant from AirLiquide; a lecture fee from Springer; an educational grant from Westfalen Medical; an educational grant and a lecture fee from SomnoMed; educational grants from Vivisol, Total Care, Medidis, Fisher & Paykel, Wave Medical, OSG, Mediq Tefa, NightBalance and Heinen & Löwenstein; lecture fees from AstraZeneca; and educational grants from Accuramed, Bekaert Deslee Academy and UCB Pharma, all outside the submitted work. Conflict of interest: W.T. McNicholas has nothing to disclose. Conflict of interest: A. Pataka has nothing to disclose. Conflict of interest: P. Sliwinski has nothing to disclose. Conflict of interest: Ö.K. Basoglu has nothing to disclose.
(Copyright ©The authors 2021.)