Obstructive sleep apnea: personalizing CPAP alternative therapies to individual physiology

ABSTRACT

Introduction

The recent continuous positive airway pressure (CPAP) crisis has highlighted the need for alternative obstructive sleep apnea (OSA) therapies. This article serves to review OSA pathophysiology and how sleep apnea mechanisms may be utilized to individualize alternative treatment options.

Areas covered

The research highlighted below focuses on 1) mechanisms of OSA pathogenesis and 2) CPAP alternative therapies based on mechanism of disease. We reviewed PubMed from inception to July 2022 for relevant articles pertaining to OSA pathogenesis, sleep apnea surgery, as well as sleep apnea alternative therapies.

Expert opinion

Although the field of individualized OSA treatment is still in its infancy, much has been learned about OSA traits and how they may be targeted based on a patient’s physiology and preferences. While CPAP remains the gold-standard for OSA management, several novel alternatives are emerging. CPAP is a universal treatment approach for all severities of OSA. We believe that a personalized approach to OSA treatment beyond CPAP lies ahead. Additional research is needed with respect to implementation and combination of therapies longitudinally, but we are enthusiastic about the future of OSA treatment based on the data presented here.

KEYWORDS:

• Obstructive sleep apnea
• sleep apnea
• CPAP
• sleep apnea surgery
• control of breathing
• personalized sleep medicine

Article highlights

• Obstructive sleep apnea is exceedingly common.

• The 2021 global CPAP shortage has highlighted the need for alternative therapies for OSA treatment.

• The future of OSA treatment lies in tailoring therapies to the underlying mechanism of disease.

• Current alternatives to CPAP include mandibular advancement devices, sleep apnea surgery, hypoglossal nerve stimulation, oropharyngeal muscle training therapy, and positional therapy.

• Here we present a nuanced view of OSA pathophysiology as well as how therapies can be adapted to individual sleep traits.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received personal fees as a consultant for Apnimed, Inc. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.