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Obstructive Sleep ApneaNCT06825923

Precision OSA Therapy Based on Phenotypes and Endotypes

An observational study of Obstructive Sleep Apnea, run by Nanjing Medical University at 1 site in China.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Analyzing the phenotypic and endotypic characteristics of Sleep Apnea, along with DISE obstruction situations, is crucial for precise diagnosis and treatment. In this study, we aim to construct and apply a multidimensional predictive model based on four aspects: basic physiological characteristics of OSA, clinical… Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Obstructive Sleep Apnea
What is being tested?
Clinical and Endotypic Assessmen
How many people
200 participants
Where
1 siteChina
Study dates
1 Jul 2025to 31 Dec 2029
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: This study will involve participants diagnosed with OSA who are not currently undergoing any active treatment for the condition. The study aims to explore the detailed phenotypic and endotypic characteristics of these patients to better understand OSA dynamics and develop predictive models for individualized treatment approaches.

Who may be able to join

  • Patients aged between 18 and 80 years.
  • Diagnosed with Obstructive Sleep Apnea (OSA)(apnea-hypopnea index≥5/h).
  • First-time diagnosis, with no previous surgical interventions or CPAP treatment for OSA.
  • Ability and willingness to provide informed consent for participation in the study.

Who cannot join

  • History of severe stroke or cerebral hemorrhage, or presence of neurological or psychiatric conditions that could affect study results.
  • Presence of active malignancies or other severe underlying diseases, such as severe liver or kidney dysfunction. Diagnosed with diabetes or other significant vascular diseases.
  • Presence of severe chronic obstructive pulmonary disease (COPD), severe asthma, severe pulmonary hypertension, or heart failure caused by any condition.
  • Pregnancy or having other conditions that make participation in this study unsuitable.
  • Extremely debilitated patients or those with severe underlying conditions.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Ding Ning, doctor contact

86-25-68136723

dr.ningding@live.cn

China1 site
  • The First Affiliated Hospital of Nanjing Medical University

    Nanjing, Jiangsu, 210029

Other trials in China

About this study

Official title: Precise Intervention of Obstructive Sleep Apnea Based on Phenotypic Characteristics and Endotypic Mechanisms

Analyzing the phenotypic and endotypic characteristics of Sleep Apnea, along with DISE obstruction situations, is crucial for precise diagnosis and treatment. In this study, we aim to construct and apply a multidimensional predictive model based on four aspects: basic physiological characteristics of OSA, clinical phenotypes, mechanistic endotypes, and DISE obstruction levels. The study will begin by categorizing the clinical phenotypes; subsequently, it will quantify endotypic indicators based on PSG signal information and construct the PALM scale for Chinese individuals. Following this, a comprehensive clinical profile and a treatment efficacy prediction model for OSA patients will be built based on the results from the aforementioned multidimensional data.

Read the detailed description

Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of upper airway obstruction and apneas during sleep, resulting in chronic intermittent hypoxemia, autonomic fluctuations, and sleep fragmentation. OSA is a heterogeneous disease influenced by multifactorial elements. The effectiveness of treatments and prognoses may vary due to differences in etiological factors, pathophysiological mechanisms, and clinical subtypes. Zinchuk et al. identified four clinical symptom and comorbidity-based subtypes and two subtypes based on polysomnography (PSG) indicators, which are useful for guiding treatment. However, relying solely on external phenotypes does not allow for analysis of intrinsic mechanisms, often leading to large treatment outcome disparities within the same phenotype due to different underlying mechanisms. Thus, the concept of OSA endotypes, which can elucidate pathophysiological mechanisms, has been introduced. OSA phenotypes are broadly defined as a classification of OSA patients related to clinically significant attributes such as symptoms, treatment response, underlying diseases, and quality of life; whereas endotypes refer to disease subtypes with distinct functional or pathophysiological mechanisms. There are at least four key pathophysiological endotypes in OSA, including 1) high upper airway closing pressure (Pcrit), 2) low arousal threshold (ArThr), 3) high loop gain (LG), and 4) impaired pharyngeal dilator muscle responsiveness. Each endotype represents a target or "treatable trait" from a mechanistic perspective. The advantages of OSA endotype quantification based on PSG signal information are evident. Eckert et al. proposed a potential classification of OSA patients into three subgroups based on the impairment of upper airway anatomy and the non-anatomical phenotypes (loop gain, arousal threshold, and muscle responsiveness) - the PALM scale. This phenotyping introduces different possible therapeutic strategies.

The same PSG outcomes may be caused by different endotypic mechanisms, and different endotypic mechanisms may lead to varying PSG outcomes, resulting in inconsistent treatment effects. To accurately align endotypes with PSG outcomes, a standard for obstruction anchoring is essential. Drug-induced sleep endoscopy (DISE) offers a bridge between the two by providing an assessment of the severity and plane of upper airway obstruction, which is related to both the severity of apneas and the upper airway closing pressure in the PALM model. In our preliminary research, the measurement of upper airway closing pressure and muscle responsiveness was achievable through DISE-PAP. Given the importance of distinguishing OSA patient phenotypic characteristics, quantifying endotypes, developing new indices, and assessing DISE obstruction planes, this study aims to construct and apply a multidimensional predictive model that integrates basic physiological characteristics of OSA, clinical phenotypes, mechanistic endotypes, and DISE obstruction planes. The study will start with the classification of clinical phenotypes, followed by the quantification of endotypic indicators based on PSG signal information and the construction of a PALM scale suitable for Chinese individuals. Subsequently, based on the results from the aforementioned multidimensional data, a comprehensive clinical portrait and predictive model of treatment outcomes for OSA patients will be built.

Being tested
Clinical and Endotypic Assessmen
Keywords
Obstructive Sleep Apnea, PALM, Phenotype, Endotype
Medical subject headings
Sleep Apnea, Obstructive

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Clinical and Endotypic AssessmenOther

    This observational study involves a detailed clinical and endotypic assessment of patients diagnosed with Obstructive Sleep Apnea (OSA). Assessments include polysomnography (PSG) to measure sleep patterns and disturbances, drug-induced sleep endoscopy (DISE) to evaluate upper airway obstruction, and various biomarker analyses to characterize endotypic traits. The study aims to collect comprehensive phenotypic and endotypic data to develop predictive models for OSA patient characterization and management.

Study groups in NCT06825923
Study groupRoleWhat they receive
OSA Comprehensive Assessment GroupThis group comprises patients diagnosed with Obstructive Sleep Apnea (OSA). Participants will undergo a comprehensive assessment that includes baseline demographic data collection, clinical symptom evaluation, polysomnography (PSG), Drug-Induced Sleep Endoscopy (DISE), and various physiological measurements to identify specific phenotypic and endotypic traits associated with OSA. This holistic evaluation aims to facilitate detailed phenotyping and generate predictive models for personalized treatment approaches.
Receives: Other: Clinical and Endotypic Assessmen

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Phenotype and Endotype Classification

    This outcome measure will evaluate the new phenotypic and endotypic features in OSA patients by integrating various clinical symptoms, traditional and novel PSG metrics, upper airway imaging indicators, diaphragm morphology and function parameters, and DISE results. A comprehensive classification system will be developed by combining these data points to classify OSA patients into distinct clinical phenotypes and endotypes. This classification aims to provide insights into the underlying pathophysiology of OSA and to better understand patient-specific characteristics for personalized treatment plans.

    Measured: 12 months post-enrollment.

  2. Multidimensional Predictive Model

    This outcome measure will assess the effectiveness of a multidimensional predictive model constructed using clinical phenotype, endotype, novel biomarkers, and DISE results. We used six commonly employed supervised machine learning algorithms: Random Forest, XGBoost, Support Vector Classifier (SVC), Logistic Regression, Multi-layer Perceptron (MLP), and Stacking Regression to classify OSA patients based on their survival status. The Stacking Regression model was designed by combining the outputs of Random Forest, XGBoost, and Support Vector Regression. The best-performing model will be selected to compute the final prediction, providing a powerful tool to predict the treatment response and clinical outcomes for OSA patients.

    Measured: End of the study, expected 24 months after enrollment.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Feb 2025
  2. Study start1 Jul 2025 (estimated)
  3. Primary completion31 Dec 2027 (estimated)
  4. Study completion31 Dec 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06825923
Sponsor's protocol ID
2025-SRFA-006
Status last verified
Feb 2025
First submitted
4 Feb 2025
Last updated
13 Feb 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: The individual participant data will not be shared. The informed consent will be ansigned before enrolled in the study and ensured to keep personal information confidential.

Publications

  • Zinchuk A, Yaggi HK. Phenotypic Subtypes of OSA: A Challenge and Opportunity for Precision Medicine. Chest. 2020 Feb;157(2):403-420. doi: 10.1016/j.chest.2019.09.002. Epub 2019 Sep 17.

    PubMed 31539538
  • Zinchuk AV, Gentry MJ, Concato J, Yaggi HK. Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches. Sleep Med Rev. 2017 Oct;35:113-123. doi: 10.1016/j.smrv.2016.10.002. Epub 2016 Oct 12.

    PubMed 27815038
  • Aishah A, Eckert DJ. Phenotypic approach to pharmacotherapy in the management of obstructive sleep apnoea. Curr Opin Pulm Med. 2019 Nov;25(6):594-601. doi: 10.1097/MCP.0000000000000628.

    PubMed 31503212
  • Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013 Oct 15;188(8):996-1004. doi: 10.1164/rccm.201303-0448OC.

    PubMed 23721582
  • Eckert DJ. Phenotypic approaches to obstructive sleep apnoea - New pathways for targeted therapy. Sleep Med Rev. 2018 Feb;37:45-59. doi: 10.1016/j.smrv.2016.12.003. Epub 2016 Dec 18.

    PubMed 28110857
  • Van den Bossche K, Van de Perck E, Kazemeini E, Willemen M, Van de Heyning PH, Verbraecken J, Op de Beeck S, Vanderveken OM. Natural sleep endoscopy in obstructive sleep apnea: A systematic review. Sleep Med Rev. 2021 Dec;60:101534. doi: 10.1016/j.smrv.2021.101534. Epub 2021 Aug 3.

    PubMed 34418668

Questions about this trial

What is this clinical trial studying?

An observational study of Obstructive Sleep Apnea, run by Nanjing Medical University at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 13 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Ding Ning, doctor (86-25-68136723, dr.ningding@live.cn), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Phenotype and Endotype Classification (time frame: 12 months post-enrollment.). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06825923, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Feb 2025.

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