The modified Baveno classification for obstructive sleep apnoea: development and evaluation based on the ESADA database

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 Database (ESADA) were retrospectively allocated into CVD risk groups 1–3 based on the SCORE2 risk prediction model and European Society of Cardiology guidelines. AHI ≥30 events·h−1 conferred strong treatment indication. When AHI was <30 events·h−1, symptoms and CVD risk dictated allocation to the weak, intermediate or strong treatment indication group. Changes in Epworth Sleepiness Scale (ESS) score 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; median (interquartile range) age 56 (49–64) years and body mass index 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 median SBP occurred when AHI was ≥30 events·h−1 and in symptomatic patients with CVD risk levels >1 when AHI was <30 events·h−1. 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.