Baveno Classification Versus Polysomnography in Obstructive Sleep Apnea

Obstructive sleep apnea is a heterogeneous disorder characterized not only by the frequency of respiratory events during sleep but also by variable symptom burden and associated comorbidities. While polysomnography remains the reference standard for diagnosis and severity classification, reliance on respiratory event indices alone may not fully capture the clinical complexity of the disease. The Baveno classification has been proposed as a multidimensional approach that incorporates symptom burden and comorbidity status to support individualized management strategies.

This retrospective observational study evaluates the relationship between the Baveno classification and polysomnography-based findings in patients with obstructive sleep apnea. The study population consists of adult patients who underwent overnight polysomnography in a tertiary care sleep laboratory between January 2016 and June 2024. Demographic, clinical, and sleep study data were retrieved from institutional electronic medical records and sleep laboratory archives.

Patients were categorized according to polysomnography-based disease severity using the apnea-hypopnea index and separately classified into Baveno groups based on symptom burden and the presence of comorbid conditions. The analysis focuses on the level of agreement between these two classification approaches and their implications for treatment decision-making. In particular, concordance in treatment recommendations derived from each classification framework is examined.

By comparing a physiology-based diagnostic standard with a clinically oriented classification system, this study aims to provide further evidence regarding the applicability of multidimensional assessment strategies in the management of obstructive sleep apnea.

Inclusion criteria

• Age ≥18 years
• Patients diagnosed with obstructive sleep apnea
• Patients who underwent full-night diagnostic polysomnography
• Availability of complete polysomnographic parameters, including apnea-hypopnea index, oxygen desaturation index, and oxygen saturation measurements
• Availability of clinical variables required for Baveno classification
• Patients evaluated between January 2016 and June 2024
• Availability of complete electronic medical records

Exclusion criteria

• Age <18 years
• Central sleep apnea syndrome
• Prior positive airway pressure therapy before diagnostic polysomnography
• Incomplete polysomnography data
• Missing clinical or laboratory records required for Baveno classification
• Duplicate patient records
• Repeated polysomnography examinations from the same patient (only the first eligible sleep study included)
• Severe technical artifacts affecting polysomnography interpretation
• Pregnancy
• Neuromuscular disorders affecting respiratory function
• Acute respiratory infection during sleep testing