Neuroscience Research Australia and the University of New South Wales, Randwick, Sydney, Australia.
Neuroscience Research Australia and the University of New South Wales, Randwick, Sydney, Australia.
Chest. 2018 Mar;153(3):744-755. doi: 10.1016/j.chest.2017.06.011. Epub 2017 Jun 16.
OSA is a heterogeneous disorder. If left untreated, it has major health, safety, and economic consequences. In addition to varying levels of impairment in pharyngeal anatomy (narrow/collapsible airway), nonanatomical "phenotypic traits" are also important contributors to OSA for most patients. However, the majority of existing therapies (eg, CPAP, oral appliances, weight loss, positional therapy, upper airway surgery) target only the anatomical cause. These are typically administered as monotherapy according to a trial and error management approach in which the majority of patients are first prescribed CPAP. Despite its high efficacy, CPAP adherence remains unacceptably low, and second-line therapies have variable and unpredictable efficacies. Recent advances in knowledge regarding the multiple causes of OSA using respiratory phenotyping techniques have identified new targets or "treatable traits" to direct therapy. Identification of the traits and development of therapies that selectively target one or more of the treatable traits has the potential to personalize the management of this chronic health condition to optimize patient outcomes according to precision medicine principles. This brief review highlights the latest developments and emerging therapies for personalized management approaches for OSA.
阻塞性睡眠呼吸暂停（OSA）是一种异质性疾病。如果不加以治疗，它会对健康、安全和经济造成重大影响。除了咽腔解剖结构（气道狭窄/塌陷）不同程度受损外，大多数患者的非解剖“表型特征”也是 OSA 的重要致病因素。然而，大多数现有疗法（如 CPAP、口腔矫治器、减肥、体位疗法、上气道手术）仅针对解剖原因。这些疗法通常根据试错管理方法进行单一疗法，即首先为大多数患者开具 CPAP 处方。尽管 CPAP 的疗效很高，但 CPAP 的依从性仍然低得令人无法接受，二线疗法的疗效也各不相同且不可预测。使用呼吸表型技术了解 OSA 的多种病因的最新进展，确定了新的治疗靶点或“可治疗特征”，以指导治疗。根据精准医疗原则，确定这些特征并开发针对一种或多种可治疗特征的治疗方法，有可能根据患者的具体情况对这种慢性健康状况进行个体化管理，以优化患者的治疗效果。本文简要综述了 OSA 个体化治疗方法的最新进展和新兴疗法。
