Abstract
Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional continuous positive airway pressure (CPAP)-focused, “one size fits all” trial-and-error approach, which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes) that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. Additionally, these concepts have provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.
Abstract
Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnoea (OSA) requires alternatives. Recent advances in knowledge of OSA pathogenesis, alternatives or adjuncts to CPAP and novel approaches will allow more personalised treatments.https://bit.ly/3ieyDRG
Footnotes
Previous articles in this series: No. 1:Osorio RS, Martínez-García MA, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future.Eur Respir J2022; 59: 2101649.No. 2:Lévy P, Naughton MT, Tamisier R,et al.Sleep apnoea and heart failure.Eur Respir J2022; 59: 2101640.
Number 3 in the series “Challenges in sleep apnoea” Edited by P. Lévy and M.A. Martínez-García
Conflict of interest: J-L Pepin has received lecture fees or conference travelling grants from ResMed, Philips, Fisher and Paykel, AstraZeneca, Jazz Pharmaceuticals, Agiradom, and Bioprojet, and has received unrestricted research funding from ResMed, Philips, Bioprojet, Fondation de la Recherche Medicale (Foundation for Medical Research), Direction de la Recherche Clinique du CHU de Grenoble (Research Branch Clinic CHU de Grenoble), and fond de dotation “Agir pour les Maladies Chroniques” (endowment fund “Acting for Chronic Diseases”).
Conflict of interest: P. Eastwood has research grants from Philips, Zelira Therapeutics, Oventus and Nyxoah, and is a member of the scientific advisory board for Zelira Therapeutics and Nyxoah, outside the submitted work.
Conflict of interest: D.J. Eckert has a Collaborative Research Centre (CRC-P) grant, a consortium grant between the Australian Government, Academia and Industry (industry partner: Oventus Medical) and has research grants and serves as a consultant for Bayer and Apnimed.
Support statement: J-L. Pépin is supported by a research grant from the French National Research Agency (ANR-12-TECS-0010), in the framework of the “Investissements d'avenir” programme (ANR-15-IDEX-02) and the “e-health and integrated care” chair of excellence from the Grenoble Alpes University Foundation. D.J. Eckert is supported by a National Health and Medical Research Council of Australia (NHMRC) senior research fellowship (1116942) and an investigator grant (1196261). Funding information for this article has been deposited with theCrossref Funder Registry.
- ReceivedJune 24, 2021.
- AcceptedSeptember 16, 2021.
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