Personalized Medicine and Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) is a common disease that is often under-diagnosed and under-treated in all ages. This is due to differences in morphology, diversity in clinical phenotypes, and differences in diagnosis and treatment of OSA in children and adults, even among individuals of the same age. Therefore, a personalized medicine approach to diagnosis and treatment of OSA is necessary for physicians in clinical practice. In children and adults without serious underlying medical conditions, polysomnography at sleep labs may be an inappropriate and inconvenient testing modality compared to home sleep apnea testing. In addition, the apnea–hypopnea index should not be considered as a single parameter for making treatment decisions. Thus, the treatment of OSA should be personalized and based on individual tolerance to sleep-quality-related parameters measured by the microarousal index, harmful effects of OSA on the cardiovascular system related to severe hypoxia, and patients’ comorbidities. The current treatment options for OSA include lifestyle modification, continuous positive airway pressure (CPAP) therapy, oral appliance, surgery, and other alternative treatments. CPAP therapy has been recommended as a cornerstone treatment for moderate-to-severe OSA in adults. However, not all patients can afford or tolerate CPAP therapy. This narrative review seeks to describe the current concepts and relevant approaches towards personalized management of patients with OSA, according to pathophysiology, cluster analysis of clinical characteristics, adequate combined therapy, and the consideration of patients’ expectations.

The role of orthodontics in obstructive sleep apnea and Hypopnea Syndrome in children

“…The most frequently affected age group is between 2 and 8 years of age, regardless of gender. However, male children show a higher risk than female children after puberty (4,5).…”

“…The prevalence in children of this syndrome varies between 2-10%, depending on the population studied, and with a considerable increase in obese children (2)(3)(4). The most frequently affected age group is between 2 and 8 years of age, regardless of gender.…”

“…According to the American Academy of Pediatrics, the evaluation of problems of this nature should be part of the routine of professionals who serve children, because often parents may not perceive or do not consider as a major problem in the quality of their children's sleep. Children with OSAHS often do not present a quality of life and may develop cardiovascular problems, neurobehavioral deficits, and other future impairments (3)(4)(5).…”

“…Although the pathophysiology is multifactorial in children, the most common etiological factor is upper airway obstruction (2)(3)(4)(5). Figure 1 shows the anatomical structures related to the upper airways, starting from the nose to the region of the laryngopharynx (lower border of the cricoid cartilage) and divided into nasopharynx, mouth, or oropharynx and laryngopharynx.…”

“…It is important to consider that apnea can have a central, obstructive, and mixed origin (4). Although this chapter deals with obstructive apnea, the other possibilities should not be disregarded.…”