Ventilatory Burden: Development of a New Approach to Better Quantify Obstructive Sleep Apnea Severity and Its Impacts

Neutral and inconsistent findings for obstructive sleep apnea (OSA) treatment trials across a range of outcomes have motivated recent efforts to better define OSA severity. Strategies have included novel in-home technology to quantify the apnea–hypopnea index (AHI) over multiple nights to reduce the high rates of disease misclassification associated with current single-night diagnostic approaches. Techniques to identify different OSA endophenotypes to help increase success rates with existing therapies and develop new therapies that target specific pathophysiological causes have also been developed. In addition, new markers of OSA severity based on specific pathophysiological consequences of OSA have been established. Examples include hypoxic burden to capture both the frequency and severity of OSA-related hypoxia and electroencephalogram-based markers to better quantify OSA-related sleep disruption such as arousal burden, odds ratio product, and quantitative measures of sleep depth and pattern. These physiology-based markers of sleep and breathing disruption better predict important health outcomes such as sleepiness, cardiovascular events, and all-cause mortality than traditional polysomnography metrics such as the AHI...