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Phenotypic approach to pharmacotherapy in the management of obstructive sleep apnoea

Aishah, Atqiyaa; Eckert, Danny J.a,b

Current Opinion in Pulmonary Medicine: November 2019 - Volume 25 - Issue 6 - p 594–601
doi: 10.1097/MCP.0000000000000628
SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Brian D. Kent
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Purpose of review To provide a concise synthesis of the current knowledge of obstructive sleep apnoea (OSA) phenotyping concepts and how this information is being used to develop and direct targeted pharmacotherapy for OSA.

Recent findings The causes of OSA vary between patients and therefore so too does the optimal therapy or therapies. Key phenotypic causes include impaired upper airway anatomy and non-anatomical contributors such as ineffective pharyngeal dilator muscles during sleep, waking up too easily to minor airway narrowing (low arousal threshold) and unstable respiratory control (high loop gain). Traditionally, heterogeneity of OSA pathophysiology was not considered in pharmacotherapy approaches for OSA. However, recent study has focussed on targeted pharmacotherapies directed towards specific OSA phenotypes. This, combined with advances in knowledge of the neurobiology of pharyngeal muscle control from animal studies that have recently been translated to human proof-of-concept studies by repurposing existing drugs that target the desired mechanisms, have opened up exciting new lines of investigation for OSA pharmacotherapy.

Summary There have been major recent advances in the development of new targeted approaches to pharmacotherapy for OSA. This study shows considerable promise for a viable and much needed pathway to drug therapy for this common chronic health condition.

aNeuroscience Research Australia (NeuRA), University of New South Wales (UNSW), Randwick, Sydney, New South Wales

bAdelaide Institute for Sleep Health (AISH), Flinders University, South Australia, Australia

Correspondence to Danny J. Eckert, AISH, Flinders University, Box 6, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, South Australia 5042, Australia. E-mail: danny.eckert@flinders.edu.au

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