Phenotyping of Obstructive Sleep Apnea Syndrome and Association with Cognitive Impairment, a Real-Life Study

Capilupi, Filippo; Condoleo, Valentino; Severini, Giandomenico; Armentaro, Giuseppe; Pelaia, Corrado; Gareri, Ilaria; Loiacono, Pasquale; Scarcelli, Maria Rosangela; Maruca, Francesco; Panza, Alberto; Panza, Marilisa; Miceli, Sofia; Maio, Raffaele; Sciacqua, Angela

doi:10.3390/biomedicines14061187

Open AccessArticle

Phenotyping of Obstructive Sleep Apnea Syndrome and Association with Cognitive Impairment, a Real-Life Study

by

Filippo Capilupi

^1,†,

Valentino Condoleo

^2,†,

Giandomenico Severini

^2,†

,

Giuseppe Armentaro

^2,*

,

Corrado Pelaia

³

,

Ilaria Gareri

¹,

Pasquale Loiacono

¹,

Maria Rosangela Scarcelli

¹,

Francesco Maruca

¹,

Alberto Panza

¹,

Marilisa Panza

¹,

Sofia Miceli

²,

Raffaele Maio

²

and

Angela Sciacqua

^1,2

¹

Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy

²

Geriatrics Division, “Renato Dulbecco” University Hospital of Catanzaro, 88100 Catanzaro, Italy

³

Department of Health Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Biomedicines 2026, 14(6), 1187; https://doi.org/10.3390/biomedicines14061187

Submission received: 24 February 2026 / Revised: 14 May 2026 / Accepted: 20 May 2026 / Published: 24 May 2026

(This article belongs to the Special Issue Obstructive Sleep Apnea: Mechanisms, Comorbidities, and Optimization of Emerging and Established Therapies)

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Abstract

Introduction: Obstructive sleep apnea (OSA) is highly prevalent, affecting up to 50% of individuals over 65 years. Elderly patients often present with atypical, fewer and less severe symptoms, suggesting age-specific phenotypes. However, comprehensive clinical phenotyping that incorporates cognitive outcomes remains limited. This study aimed to characterize OSA phenotypes through cluster analysis and evaluate their association with cognitive impairment, independently of age. Materials and Methods: Between 2020 and 2024, 409 adults with moderate-to-severe OSA were enrolled and stratified into three age groups (<65, 65–74, ≥75 years). All underwent home sleep apnea testing (HSAT), comprehensive symptom assessment, Epworth Sleepiness Scale (ESS), and Montreal Cognitive Assessment (MoCA, pathological ≤ 25 pts). Hierarchical cluster analysis (Ward’s method) used AHI, T90, BMI, and ESS. Logistic regression identified independent predictors of cognitive impairment. Results: Older groups showed lower BMI, higher comorbidity burden, fewer symptoms, and greater cognitive impairment prevalence (4.5% vs. 9.7% vs. 45.9%; p < 0.001), despite comparable polysomnographic severity across age groups. Cluster analysis identified three phenotypes: Cluster 1 (classical OSA: high AHI, BMI, T90, ESS); Cluster 2 (geriatric phenotype: low AHI, BMI, T90, ESS, highest cognitive impairment rate: 27.7%); Cluster 3 (hypersymptomatic: low AHI and T90, high sleepiness and asthenia, prevalent depression). On multivariate regression, age (OR 1.155; p < 0.001), male sex (OR 2.223; p = 0.034), and Cluster 2 (OR 3.131; p < 0.001) were independent predictors of cognitive impairment. Conclusions: Three clinically distinct OSA phenotypes were identified regardless of age and severity. The geriatric phenotype was associated with three-fold increased risk of cognitive impairment, supporting routine cognitive screening and age-adapted diagnostic strategies in elderly OSA patients.

Keywords: obstructive sleep apnea; phenotyping; cluster analysis; cognitive impairment; elderly; aging

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MDPI and ACS Style

Capilupi, F.; Condoleo, V.; Severini, G.; Armentaro, G.; Pelaia, C.; Gareri, I.; Loiacono, P.; Scarcelli, M.R.; Maruca, F.; Panza, A.; et al. Phenotyping of Obstructive Sleep Apnea Syndrome and Association with Cognitive Impairment, a Real-Life Study. Biomedicines 2026, 14, 1187. https://doi.org/10.3390/biomedicines14061187

AMA Style

Capilupi F, Condoleo V, Severini G, Armentaro G, Pelaia C, Gareri I, Loiacono P, Scarcelli MR, Maruca F, Panza A, et al. Phenotyping of Obstructive Sleep Apnea Syndrome and Association with Cognitive Impairment, a Real-Life Study. Biomedicines. 2026; 14(6):1187. https://doi.org/10.3390/biomedicines14061187

Chicago/Turabian Style

Capilupi, Filippo, Valentino Condoleo, Giandomenico Severini, Giuseppe Armentaro, Corrado Pelaia, Ilaria Gareri, Pasquale Loiacono, Maria Rosangela Scarcelli, Francesco Maruca, Alberto Panza, and et al. 2026. "Phenotyping of Obstructive Sleep Apnea Syndrome and Association with Cognitive Impairment, a Real-Life Study" Biomedicines 14, no. 6: 1187. https://doi.org/10.3390/biomedicines14061187

APA Style

Capilupi, F., Condoleo, V., Severini, G., Armentaro, G., Pelaia, C., Gareri, I., Loiacono, P., Scarcelli, M. R., Maruca, F., Panza, A., Panza, M., Miceli, S., Maio, R., & Sciacqua, A. (2026). Phenotyping of Obstructive Sleep Apnea Syndrome and Association with Cognitive Impairment, a Real-Life Study. Biomedicines, 14(6), 1187. https://doi.org/10.3390/biomedicines14061187

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Phenotyping of Obstructive Sleep Apnea Syndrome and Association with Cognitive Impairment, a Real-Life Study

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