Sânchez-de-la-Torre Manuel, Gozal David
Hospital Universitari Arnau de Vilanova and Santa Maria. Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain, Hospital San Pedro de Alcántara, Cáceres, Spain.
Expert Rev Precis Med Drug Dev. 2017;2(4):217-228. doi: 10.1080/23808993.2017.1361319. Epub 2017 Aug 9.
Obstructive sleep apnea (OSA) is a highly prevalent condition that is viewed as a major global health concern, while affecting approximately 10% of the middle-aged population. OSA is a chronic disease that has been conclusively associated with poor quality of life, cognitive impairments and mood alterations, enhanced cardiovascular and metabolic morbidity, thereby leading to marked increments in healthcare costs.
The authors have reviewed the current evidence on the pathophysiology of OSA and its consequences, the heterogeneity of its phenotypic expression, the current therapeutic applications and their efficacy, and the implications for diagnosis, treatment and follow-up strategies in the context of the clinical management of OSA.
Personalized medicine in OSA identifies different needs and approaches: i) phenotyping and defining the different and segregated clusters of OSA patients whose recognition may improve prognostic predictions and guide therapeutic strategies; ii) to further characterize and predict the impact of OSA and its treatment, particularly revolving around mortality and the processes closely related to ageing (cardiovascular diseases, cancer and neurocognitive diseases); iii) the introduction of new technologies including telemedicine that have shown promise in the implementation of personalized medicine approaches.
阻塞性睡眠呼吸暂停(OSA)是一种高度普遍的病症,被视为全球主要的健康问题,影响着约10%的中年人群。OSA是一种慢性病,已被确凿地证明与生活质量差、认知障碍和情绪改变、心血管和代谢发病率增加有关,从而导致医疗费用显著增加。
作者回顾了关于OSA病理生理学及其后果、表型表达的异质性、当前治疗应用及其疗效的现有证据,以及在OSA临床管理背景下对诊断、治疗和随访策略的影响。
OSA的个性化医疗确定了不同的需求和方法:i)对OSA患者进行表型分析并定义不同的、相互隔离的群体,识别这些群体可能会改善预后预测并指导治疗策略;ii)进一步表征和预测OSA及其治疗的影响,特别是围绕死亡率以及与衰老密切相关的过程(心血管疾病、癌症和神经认知疾病);iii)引入包括远程医疗在内的新技术,这些技术在实施个性化医疗方法方面已显示出前景。