Abstract
Obstructive sleep apnoea (OSA) is challenging medical problem due to its prevalence, its impact on quality of life and performance in school and profession, the implications on risk of accidents and comorbidities and mortality. Current research has carved out a broad spectrum of clinical phenotypes and defined major pathophysiological components. These findings indicate to the concept of personalised therapy, oriented on both the distinct clinical presentation and the most relevant pathophysiology in the individual patient. This leads to the question if sufficient therapeutical options other than positive airway pressure (PAP) alone are available, for which patients they may be useful, if there are specific indications for single or combined treatment, and if there is solid scientific evidence for recommendations. This review describes our knowledge on PAP and non-PAP therapies to address upper airway collapsibility, muscle responsiveness, arousability and respiratory drive. The spectrum is broad and heterogeneous, including technical and pharmaceutical options, already in clinical use or in an advanced experimental stage. Although there is an obvious need for more research on single or combined therapies, the available data demonstrate the variety of effective options, which should replace the unidirectional focus on PAP therapy.
Footnotes
This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.
Conflict of interest: Verbraecken Johan reports grants or contracts received from Philips Respironics, Heinen & Löwenstein, ResMed, Total Care, Fisher & Paykel, Bioprojet, Jazz Pharmaceutics, AirLiquide, Total Care, Westfalen Medical, Somnomed, Medidis, Wave Medical, OSG, Mediq Tefa, NightBalance, Accuramed, Bekaert Deslee Academy, UCB Pharma, Vivisol, and Inspire Medical Systems, outside the submitted work. Consulting fees received from Vemedia. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events received from Sanofi, Agfa-Gevaert, Astra-Zeneca, TotalCare, Springer, and OSA Academy. Support for attending meetings and/or travel received from Bioprojet. Participation on a Data Safety Monitoring Board or Advisory Board for Bioprojet, Oxford Pharmagenesis, Idorsia, MSD, and Desitin. Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid; President (up to 8/2021) and past president Belgian Association for Sleep research and Sleep medicine (since 9/2021. All disclosures made outside the submitted work.
Conflict of interest: Winfried Randerath reports receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Weinmann, Heinen & Löwenstein, Resmed, Jazz Pharmaceuticals, Inspire, Philips Respironics, Bioprojet, and Vanda Pharma. Support for attending meetings and/or travel received from Heinen & Löwenstein, Resmed, Jazz Pharmaceuticals, Inspire, Philips Respironics, and Bioprojet. Participation on a Data Safety Monitoring Board or Advisory Board for Bioprojet, Jazz Pharmaceuticals, and Philips Respironics. Leadership or fiduciary role in other board, society, committee or advocacy group (unpaid) for European Respiratory Society, Head Assembly 4, Sleep Disordered Breathing. All disclosures made outside the submitted work.
Conflict of interest: Joerg Steier reports patents planned, issued or pending; Named inventor on patent for KCL/GSTT: Apparatus for treatment of snoring and sleep apnoea - WO2016124739A1, disclosure made outside the submitted work.
Conflict of interest: The remaining authors have nothing to disclose.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received March 11, 2022.
- Accepted April 24, 2022.
- Copyright ©The authors 2022
This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org
