A Risk Stratification Model for Adult Patients with Obstructive Sleep Apnea: Development and Evaluation
Bibliographic record
Abstract
Despite emerging evidence that obstructive sleep apnea (OSA) may cause cardio-metabolic disturbances independently of known risk factors, the strength and significance of this association remains unclear. This thesis is comprised of three studies assessing the long term-consequences of OSA, and specifically the prognostic value of OSA-related variables for cardiovascular (CV) events, all-cause mortality and incident diabetes. Methods: The first study is a systematic review of longitudinal studies, from 1999 to 2011. Quality was assessed using published guidelines. Studies two and three linked a clinical sleep database to Ontario health administrative databases for the period of 1991 to 2011 to examine the relationship between OSA variables and a composite CV outcome and incident diabetes. For the latter, we assembled a cohort free of diabetes at baseline, as defined by health administrative data. Cox regression models were used to investigate the association between of OSA-related predictors and outcomes of interest, controlling for potential confounders. Study one identified significant relationships between OSA and all-cause mortality and composite CV outcome in men; associations with other outcomes remain uncertain. Among OSA-related variables, only apnea-hypopnea index (AHI) was a consistent predictor. Limitations of the clinically-based studies were small numbers of events, weak definitions of outcomes, and inconsistency in polysomnographic scoring criteria over time. Study two found that 1,172 (11.5%) of 10,149 participants experienced our composite CV event over a median follow-up of 68 months. In a fully adjusted model, the following OSA-related variables were significant independent predictors: time spent with oxygen saturation (SaO2) < 90%, sleep time, awakenings, periodic leg movements, heart rate, and presence of daytime sleepiness. In study three, of 8,678 cohort participants without diabetes at baseline, 1,017 (11.7%) developed incident diabetes over a median follow-up of 67 months. In fully-adjusted models, patients with AHI > 30 had a 30% higher hazard of developing diabetes than those with AHI < 5. Among other OSA-related variables, REM-AHI, and SaO2<90%, heart rate and neck circumference were associated with incident diabetes. Conclusions: Based on these studies, we demonstrated that OSA-related predictors significantly and independently contribute to the risk for occurrence of composite CV outcome and incidence diabetes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.015 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".