Open AccessMore Than the Sum of the Respiratory Events: Personalized Medicine Approaches for Obstructive Sleep Apnea
Author(s) -
Bradley A. Edwards,
Susan Redline,
Scott A. Sands,
Robert L. Owens
Publication year - 2019
Publication title -
american journal of respiratory and critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.272
H-Index - 374
eISSN - 1535-4970
pISSN - 1073-449X
DOI - 10.1164/rccm.201901-0014tr
Subject(s) - medicine , endotype , obstructive sleep apnea , continuous positive airway pressure , intensive care medicine , etiology , sleep apnea , disease , precision medicine , positive airway pressure , sleep medicine , apnea , sleep disorder , pathology , insomnia , psychiatry
Traditionally, the presence and severity of obstructive sleep apnea (OSA) have been defined by the apnea-hypopnea index (AHI). Continuous positive airway pressure is generally first-line therapy despite low adherence, because it reliably reduces the AHI when used, and the response to other therapies is variable. However, there is growing appreciation that the underlying etiology (i.e., endotype) and clinical manifestation (i.e., phenotype) of OSA in an individual are not well described by the AHI. We define and review the important progress made in understanding and measuring physiological mechanisms (or endotypes) that help define subtypes of OSA and identify the potential use of genetics to further refine disease classification. This more detailed understanding of OSA pathogenesis should influence clinical treatment decisions as well as help inform research priorities and clinical study design. In short, treatments could be individualized on the basis of the underlying cause of OSA; patients could better understand which symptoms and outcomes will respond to OSA treatment and by how much; and researchers could select populations most likely to benefit from specific treatment approaches for OSA.