From CPAP to tailored therapy for obstructive sleep Apnoea

Abstract

Obstructive Sleep Apnoea (OSA) is a common sleep disorder that is associated with daytime symptoms and a range of comorbidity and mortality. Continuous Positive Airway Pressure (CPAP) therapy is highly efficacious at preventing OSA when in use and has long been the standard treatment for newly diagnosed patients. However, CPAP therapy has well recognised limitations in real world effectiveness due to issues with patient acceptance and suboptimal usage. There is a clear need to enhance OSA treatment strategies and options. Although there are a range of alternative treatments (e.g. weight loss, oral appliances, positional devices, surgery, and emerging therapies such as sedatives and oxygen), generally there are individual differences in efficacy and often OSA will not be completely eliminated. There is increasing recognition that OSA is a heterogeneous disorder in terms of risk factors, clinical presentation, pathophysiology and comorbidity. Better characterisation of OSA heterogeneity will enable tailored approaches to therapy to ensure treatment effectiveness. Tools to elucidate individual anatomical and pathophysiological phenotypes in clinical practice are receiving attention. Additionally, recognising patient preferences, treatment enhancement strategies and broader assessment of treatment effectiveness are part of tailoring therapy at the individual level. This review provides a narrative of current treatment approaches and limitations and the future potential for individual tailoring to enhance treatment effectiveness.

Pitolisant for Daytime Sleepiness in Patients with Obstructive Sleep Apnea Who Refuse Continuous Positive Airway Pressure Treatment. A Randomized Trial

“…The study population corresponded to patients with OSA refusing or not tolerating CPAP treatment. Personalization of sleep apnea treatment is crucial (22) and is a prerequisite for optimizing adherence, which in turn leads to effectiveness. In the case of CPAP refusal or nonadherence, clinicians should attempt alternative treatments to CPAP (23) before offering solely pharmacologic treatment for sleepiness.…”

Friedman Score in Relation to Compliance and Treatment Response in Nonsevere Obstructive Sleep Apnea

“…Good treatment compliance is essential for CPAP and MAS treatment to be effective, but achieving adequate compliance is challenging, especially in CPAP treatment [9,12,30]. To limit unnecessary treatment failures and poor compliance, tools are needed to guide clinicians to choose which treatment is best suited for each individual patient [18,19]. Surgical reduction of airway obstructions, including the tongue base, has been shown to increase CPAP treatment compliance [22].…”

“…However, both CPAP and MAS treatment can successfully treat nonsevere OSA, as long as patient compliance is adequate [12,14,15]. erefore, tools are needed to help clinicians predict whether the patient is more likely to comply with CPAP or MAS treatment, and if the patient will successfully respond to MAS treatment [16][17][18][19]. e Friedman tongue position score (Friedman score) was developed to describe and classify the morphology of the oropharynx with the tongue in a natural relaxed position [20].…”

Adult obstructive sleep apnoea: Pathogenesis, importance, diagnosis and imaging

“…The principal approach to treating a narrow and collapsible pharynx that results in moderate‐to‐severe OSA is to use PAP, usually applied continuously (CPAP) to pneumatically splint the upper airway . It requires the patient to wear a mask at night to maintain airway patency and is a highly effective treatment.…”

“…For the same degree of OSA severity, Chinese patients display relatively more skeletal restriction, whereas Caucasian patients tend towards obesity . Mandibular advancement splints and surgical correction of retrognathism are effective treatments for mild‐to‐moderate and severe OSA, respectively …”