Objectives: It is unknown if symptom subtypes of obstructive sleep apnea (OSA) transition over time and what clinical factors may predict transitions. Methods: Data from the 2,643 participants of the Sleep Heart Health Study with complete baseline and 5-year follow-up visits were analyzed. Latent Class Analysis on 14 symptoms at baseline and follow up determined symptom subtypes. Individuals without OSA (AHI<5) were incorporated as a known class at each time point. Multinomial logistic regression assessed the effect of age, sex, body mass index (BMI) and AHI on specific class transitions. Results: The sample consisted of 1,408 women (53.8%) and mean (SD) age 62.4 (10.5) years. We identified four OSA symptom subtypes at both baseline and follow-up visits: minimally symptomatic, disturbed sleep, moderately sleepy and excessively sleepy. Nearly half (44.2%) of the sample transitioned to a different subtype from baseline to follow-up visits; transitions to moderately sleepy were the most common (77% of all transitions). Higher baseline age was associated with a 6% increase in odds to transit from excessively sleepy to moderately sleepy [OR (95% CI) = 1.06 (1.02, 1.12)]. Women had 2.35 times higher odds (95% CI: 1.27, 3.27) to transition from moderately sleepy to minimal symptoms. A 5-unit increase in BMI was associated with 2.29 greater odds (95% CI: 1.19, 4.38 to transition from minimal symptoms to excessively sleepy. Interpretation: While 56% of the sample did not transition their subtype over 5 years, of those who did, the likelihood of transitioning between certain subtypes was significantly associated with a higher baseline age, higher baseline BMI and with women, but was not predicted by AHI.

Sanjay R. Patel: has received grant funding through his institution from Bayer Pharmaceuticals, Philips Respironics, Respicardia, and Sommetrics unrelated to this work and has received consulting income from Apnimed, Bayer Pharmaceuticals, NovaResp Technologies, Philips Respironics, and Powell Mansfield Inc, unrelated to this work.

Research/Grant Support: The Sleep Heart Health Study was supported by the NHLBI through the following cooperative agreements: U01HL53940 (University of Washington), U01HL53941 (Boston University), U01HL63463 (Case Western Reserve University), U01HL53937 (Johns Hopkins University), U01HL53938 (University of Arizona), U01HL53916 (University of California, Davis), U01HL53 934 (University of Minnesota), U01HL63429 (Missouri Breaks Research), and U01HL539 31 (New York University). The National Sleep Research Resource was supported by the NHLBI (HL114473). P01 HL094307 (Individual Differences in Obstructive Sleep Apnea).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used only openly available human data that were originally located at The National Sleep Research Resource https://sleepdata.org/.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors