Obstructive sleep apnea is a common disorder associated with significant cardiovascular and metabolic risks. Polysomnography is considered the gold standard for diagnosis and severity assessment; however, it may not fully reflect symptom burden and comorbidity profiles. The Baveno classification has been proposed as a multidimensional clinical tool that integrates symptoms and comorbidities to guide treatment decisions.

This retrospective study aims to evaluate the agreement between the Baveno classification and polysomnography results in patients with obstructive sleep apnea. The study includes adult patients who underwent overnight polysomnography between January 2016 and June 2024. Clinical data, including symptom burden and comorbid conditions, were collected from medical records and used to classify patients according to the Baveno system.

The primary objective is to assess the concordance between the Baveno classification and polysomnography-based disease severity and treatment recommendations. Secondary analyses explore the distribution of disease severity across Baveno groups and the potential implications for clinical decision-making.

The findings of this study may provide insight into the clinical utility of the Baveno classification as a complementary tool to polysomnography in the management of 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

The study population consisted of adult patients with obstructive sleep apnea who underwent overnight polysomnography at a tertiary care sleep laboratory between January 2016 and June 2024. Participants were identified through electronic medical records and sleep laboratory archives. Only patients with complete clinical and polysomnographic data, including symptom burden and comorbidity profiles, were included. All patients were evaluated using both polysomnography-based severity classification and the Baveno classification system for comparative analysis.

Individual participant data will not be shared due to institutional policies and data protection regulations. The study is based on retrospective data collected from a single center, and although the data are anonymized, sharing is restricted to protect patient confidentiality and comply with applicable data privacy requirements.