OSA Endotyping as Targets for Treatment. How Far Have We Come?

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Pharmacology

Background:

• Obstructive sleep apnoea (OSA) is a prevalent condition significantly affecting patient quality of life and increasing comorbidity.
• Continuous positive airway pressure (CPAP) is the primary treatment for moderate to severe OSA.
• Understanding diverse endotypic factors contributing to OSA pathophysiology is crucial for developing alternative treatments.

Purpose of the Study:

• To explore emerging non-CPAP therapies for obstructive sleep apnoea.
• To investigate the role of pharmacotherapy targeting specific endotypes of OSA.
• To identify potential alternative treatments for patients with less severe OSA or CPAP non-compliance.

Main Methods:

• Review of recent reports identifying mechanisms for endotype classification in clinical practice.
• Analysis of pharmacotherapies developed to target non-anatomical endotypes of OSA.
• Evaluation of alternative treatment modalities including oral appliances, pharmacotherapy, and neurostimulation.

Main Results:

• Multiple endotypic factors, beyond upper airway narrowing, contribute to OSA.
• Effective pharmacotherapies targeting specific non-anatomical endotypes have been identified.
• Non-CPAP therapies show promise for specific patient subgroups.

Conclusions:

• While CPAP remains central for moderate-severe OSA, endotype-specific therapies, particularly pharmacotherapy, are poised to increase in importance.
• Alternative treatments offer new avenues for managing less severe OSA and improving CPAP adherence.
• Personalized medicine approaches targeting OSA endotypes represent a significant advancement in sleep disorder management.