Obstructive Sleep Apnoea: From pathogenesis to treatment: Current controversies and future directions

Abstract

Obstructive sleep apnoea (OSA) is a common disease, recognized as an independent risk factor for a range of clinical conditions, such as hypertension, stroke, depression and diabetes. Despite extensive research over the past two decades, the mechanistic links between OSA and other associated clinical conditions, including metabolic disorders and cardiovascular disease, remain unclear. Indeed, the pathogenesis of OSA itself remains incompletely understood. This review provides opinions from a number of leading experts on issues related to OSA and its pathogenesis, interaction with anaesthesia, metabolic consequences and comorbidities, cardiovascular disease, genetics, measurement and diagnosis, surgical treatment and pharmacotherapeutic targets.

Perioperative fellowship curricula in anesthesiology: a systematic review

“…22,40,41 It has significant implications for anesthesiologists, and extensive perioperative guidelines have been published with respect to its management. 22,[55][56][57] The newly formed Society of Anesthesia and Sleep Medicine indicates the wide interest in this area. 58 The role of sleep medicine will continue to gain recognition in anesthesia as increasing numbers of patients are being screened for and diagnosed with this previously unrecognized condition.…”

A resource of potential drug targets and strategic decision‐making for obstructive sleep apnoea pharmacotherapy

“…In a previous article in Respirology that focussed on controversies and future directions in OSA pathogenesis and treatment, the critical barriers that have to be overcome for any success of a potential OSA pharmacotherapy were identified 33 . Here we update and further discuss these barriers, and identify rational “druggable” targets(s) that may be on the horizon to overcome them.…”

“…Here we update and further discuss these barriers, and identify rational “druggable” targets(s) that may be on the horizon to overcome them. This approach is necessary for this review because previous attempts at OSA pharmacotherapy have largely been ineffective (for reviews see 33–38 ) and in many ways this has been predictable based on the targets chosen, and because the trials were comprised of un-phenotyped OSA patients, only a subset of which would be expected to benefit even if the pharmacological target was rational and effectively manipulated (discussed in Section 3.2). More recent clinical studies, however, using agents targeting the significant mechanisms of state-dependent pharyngeal muscle control identified from basic science experiments 39–42 , have proved beneficial when administered to phenotyped patients 43, 44 , with other studies ongoing 45–47 .…”

“…The process of identifying an effective OSA pharmacotherapy involves satisfying four over-arching requirements: (i) effectively administering a pharmacotherapy that (ii) selectively targets the critical mechanisms involved in an individual’s OSA pathogenesis (iii) at the required times (i.e., throughout the sleep period), and (iv) with minimal side effects 33 . The latter point is significant because the major neurotransmitters involved in modulating pharyngeal muscle tone across sleep-wake states 40, 48 are also involved in sleep-wake regulation and other components of cognition, mood, as well as brain and autonomic functions (e.g., 49 ) such that some off-target effects are likely.…”

ETHNOS END OBSTRUCTIVE APNEA/HYPOPNEA SYNDROME (foreign literature review)

“…В диагностике кранио-фациальных дисморфий описывается доступная, дешевая и относительно безопасная боковая цефа-лометрия (стандартизованная двухмерная боковая рентгенограмма головы и шеи для измерения ске-летных структур) [51]. Компьютерная томография, несмотря на бóльшую стоимость и радиационный риск, обеспечивает более детальные изображения поперечного сечения краниофациальных структур, особенно подходит для анализа структур верхних дыхательных путей, а магнитно-резонансная то-мография, также имея ограничения по стоимости и доступности в широкомасштабных проектах и наличии вопросов по стандартизации научно-ис-следовательских учреждений, используется для детальной оценки верхних дыхательных путей и окружающих мягких тканей [52].…”