Scoping Review Maps Symptom Phenotypes in Sleep Apnea

A scoping review published in Frontiers in Medicine has systematically mapped the variables and methods used to identify symptom-related clinical phenotypes in adults with obstructive sleep apnea (OSA). The study, led by researchers from Guangxi University of Chinese Medicine, aimed to summarize major phenotypes and their associations with treatment and health outcomes. By synthesizing evidence from thirty-six study reports, the review provides a framework for multidimensional clinical assessment and long-term follow-up in patients with OSA. The work was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

The research team conducted systematic searches across multiple databases, including PubMed, Embase, Web of Science, CINAHL, the Cochrane Library, and several Chinese biomedical databases. The search period covered literature from inception to 27 June 2026. Two reviewers independently screened records and extracted data to ensure rigor in the selection process. The unit of analysis for the synthesis was the symptom classes reported in the original studies, allowing for a detailed examination of how different research groups define and categorize patient symptoms.

Latent class analysis and cluster analysis emerged as the predominant statistical approaches used in the included studies to identify distinct phenotypes. Through descriptive cross-study synthesis, the review identified three core phenotypes: daytime sleepiness–predominant, disturbed sleep or insomnia–predominant, and minimally symptomatic. Additionally, two extended phenotypes were recognized: upper airway or respiratory interruption symptom–predominant and mixed-symptom or high symptom burden.

The review found significant differences across these phenotypes in several key areas. Patients in different groups reported variations in daytime functioning, psychological status, and overall quality of life. There were also differences in the prescription of positive airway pressure (PAP) therapy or its early use. Furthermore, the rate of symptom improvement following treatment varied among the phenotypes.

One of the critical findings was that symptom burden was not consistently aligned with objective disease burden. This discrepancy highlights the importance of considering patient-reported symptoms alongside physiological measures such as respiratory and hypoxic burden. The review also noted that some patients transitioned between symptom phenotypes over time, indicating that these categories are not static.

The authors concluded that symptom phenotypes may serve as a complementary component of multidimensional clinical assessment. They should be interpreted alongside objective respiratory and hypoxic burden, comorbidities, and treatment information. The review also suggested that symptom phenotypes may inform the assessment of changes in symptoms and functional status during long-term follow-up, offering a dynamic view of patient health.

Despite the valuable insights provided by the review, the authors acknowledged the need for future research. They recommended refining phenotype identification methods and strengthening external validation across different populations. Further examination of the associations between symptom phenotypes and treatment response is also necessary.

Subject of Research: Symptom-related clinical phenotypes in adults with obstructive sleep apnea

Article Title: Symptom-related clinical phenotypes in adults with obstructive sleep apnea: a scoping review

Article References: Wang, X., Yang, X., Li, R., Zhuang, X., Chen, T., Zhou, G., & Liang, H. (2026). Symptom-related clinical phenotypes in adults with obstructive sleep apnea: a scoping review. Frontiers in Medicine, 13, Article 1999168. https://doi.org/10.3389/fmed.2026.1999168

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1999168

Keywords: obstructive sleep apnea, clinical phenotypes, scoping review, symptom burden, positive airway pressure, sleep medicine, patient-reported outcomes, latent class analysis, Symptom-related, clinical, phenotypes, adults