Phenotyping-based treatment improves obstructive sleep apnea symptoms and severity: a pilot study

Messineo, Ludovico; Magri, R.; Corda, Luciano; Pini, Laura; Taranto‐Montemurro, Luigi; Tantucci, Claudio

doi:10.1007/s11325-017-1485-6

Cited by 22 publications

(9 citation statements)

References 35 publications

(38 reference statements)

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“…Therapies were chosen based on the baseline pathophysiological causes of OSA and were administered for two weeks: six patients took trazodone alone or in combination with other aids; five of them experienced a decrease in the number of respiratory events/hr (AHI decreased from 26 to 9 in the group as a whole after the therapy). No data related to the arousal threshold on intervention were collected [135].…”

Section: Arousal Thresholdmentioning

confidence: 99%

Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature

Taranto‐Montemurro

Messineo

Wellman

2019

JCM

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Obstructive sleep apnea (OSA) is a highly prevalent condition with few therapeutic options. To date there is no approved pharmacotherapy for this disorder, but several attempts have been made in the past and are currently ongoing to find one. The recent identification of multiple endotypes underlying this disorder has oriented the pharmacological research towards tailored therapies targeting specific pathophysiological traits that contribute differently to cause OSA in each patient. In this review we retrospectively analyze the literature on OSA pharmacotherapy dividing the medications tested on the basis of the four main endotypes: anatomy, upper airway muscle activity, arousal threshold and ventilatory instability (loop gain). We show how recently introduced drugs for weight loss that modify upper airway anatomy may play an important role in the management of OSA in the near future, and promising results have been obtained with drugs that increase upper airway muscle activity during sleep and reduce loop gain. The lack of a medication that can effectively increase the arousal threshold makes this strategy less encouraging, although recent studies have shown that the use of certain sedatives do not worsen OSA severity and could actually improve patients’ sleep quality.

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Section: Arousal Thresholdmentioning

confidence: 99%

Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature

Taranto‐Montemurro

Messineo

Wellman

2019

JCM

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“…; Messineo et al . ; Sands et al . ) and an unfavourable response to anatomical interventions (oral appliances, surgery) (Edwards et al .…”

Section: Introductionmentioning

confidence: 97%

Breath‐holding as a means to estimate the loop gain contribution to obstructive sleep apnoea

Messineo

Taranto‐Montemurro

Azarbarzin

et al. 2018

The Journal of Physiology

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Increased "loop gain" of the ventilatory control system promotes obstructive sleep apnoea (OSA) in some patients and offers an avenue for more personalized treatment, yet diagnostic tools for directly measuring loop gain in the clinical setting are lacking. Here we test the hypothesis that elevated loop gain during sleep can be recognized using voluntary breath-hold manoeuvres during wakefulness. Twenty individuals (10 OSA, 10 controls) participated in a single overnight study with voluntary breath-holding manoeuvres performed during wakefulness. We assessed (1) maximal breath-hold duration, and (2) the ventilatory response to 20 s breath-holds. For comparison, gold standard loop gain values were obtained during non-rapid eye movement (non-REM) sleep using the ventilatory response to 20 s pulses of hypoxic-hypercapnic gas (6% CO -14% O , mimicking apnoea). Continuous positive airway pressure (CPAP) was used to maintain airway patency during sleep. Additional measurements included gold standard loop gain measurement during wakefulness and steady-state loop gain measurement during sleep using CPAP dial-ups. Higher loop gain during sleep was associated with (1) a shorter maximal breath-hold duration (r = 0.49, P < 0.001), and (2) a larger ventilatory response to 20 s breath-holds during wakefulness (second breath; r = 0.50, P < 0.001); together these factors combine to predict high loop gain (receiver operating characteristic area-under-curve: 92%). Gold standard loop gain values were remarkably similar during wake and non-REM sleep. The results show that elevated loop gain during sleep can be identified using simple breath-holding manoeuvres performed during wakefulness. This may have implications for personalizing OSA treatment.

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“…CHF patients are particularly heterogeneous in terms of clinical, imaging and biological characteristics, but also concerning physiopathological traits underlying CSA/periodic breathing patterns during sleep. The overarching goal is to combine both standard clinical/biological parameters of CHF and the following complex polysomnographic patterns informing on mechanistic traits of SDB [58]. Recent studies indicate parameters possibly explaining heterogeneous response to treatment and survival, as follows.…”

Section: Is Periodic Breathing In Chf a Unique Entity?mentioning

confidence: 99%

Central sleep apnoea and periodic breathing in heart failure: prognostic significance and treatment options

et al. 2019

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Central sleep apnoea (CSA) including periodic breathing is prevalent in more than one-third of patients with heart failure and is highly and independently associated with poor outcomes. Optimal treatment is still debated and well-conducted studies regarding efficacy and impact on outcomes of available treatment options are limited, particularly in cardiac failure with preserved ejection fraction. While continuous positive airway pressure and oxygen reduce breathing disturbances by 50%, adaptive servoventilation (ASV) normalises breathing disturbances by to controlling the underlying mechanism of CSA. Results are contradictory regarding impact of ASV on hard outcomes. Cohorts and registry studies show survival improvement under ASV, while secondary analyses of the large SERVE-HF randomised trial showed an excess mortality in cardiac failure with reduced ejection fraction. The current priority is to understand which phenotypes of cardiac failure patients may benefit from treatment guiding individualised and personalised management.

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Phenotyping-based treatment improves obstructive sleep apnea symptoms and severity: a pilot study

Abstract: Treating OSA patients with a personalized combination of pharmacological and behavioral therapies according to phenotypic traits leads to a significant improvement in AHI, ODI, and subjective sleepiness.

Cited by 22 publications

References 35 publications

Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature

Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature

Breath‐holding as a means to estimate the loop gain contribution to obstructive sleep apnoea

Central sleep apnoea and periodic breathing in heart failure: prognostic significance and treatment options

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