HP2 Laboratory, INSERM U1300, University Grenoble Alpes, Grenoble, France
EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
Eur Respir J. 2022 Jun 2;59(6). doi: 10.1183/13993003.01788-2021. Print 2022 Jun.
Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional continuous positive airway pressure (CPAP)-focused, "one size fits all" trial-and-error approach, which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes) that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. Additionally, these concepts have provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.
阻塞性睡眠呼吸暂停（OSA）病理生理学和转化研究的最新进展为 OSA 的治疗和管理开辟了新的研究方向。此类研究的主要目标是提供有效、替代的治疗和管理途径，更好地针对个体风险状况进行定制，超越传统的以持续气道正压通气（CPAP）为重点、“一刀切”的试错方法，这种方法对许多患者来说往往不够充分。OSA 的不同临床表现（临床表型）和潜在病理生理表型（表型）的鉴定，为潜在机制提供了新的见解，并为这些努力提供了支持。事实上，这一新知识为 OSA 的精准医学提供了框架，以提高现有非 CPAP 治疗（如下颌前伸装置和上气道手术）和新开发的治疗（如舌下神经刺激）以及新兴治疗（如药物治疗和联合治疗）的治疗成功率。此外，这些概念还深入了解了某些患者对 CPAP 依从性的潜在生理障碍。本文综述了 OSA 发病机制、非 CPAP 治疗、临床管理方法的最新进展，并强调了未来研究的知识空白。OSA 的表型和临床表型、风险分层和个性化治疗分配方法正在迅速发展，并将从电子健康和人工智能的最新进展中进一步受益。
