Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

In all fields of medicine, major efforts are currently dedicated to improve the clinical,
physiological and therapeutic understanding of disease, and obstructive sleep apnoea (OSA) is no
exception. The personalised medicine approach is relevant for OSA, given its complex pathophysiology
and variable clinical presentation, the interactions with comorbid conditions and its possible contribution
to poor outcomes. Treatment with continuous positive airway pressure (CPAP) is effective, but CPAP is
poorly tolerated or not accepted in a considerable proportion of OSA patients. This review summarises the
available studies on the physiological phenotypes of upper airway response to obstruction during sleep,
and the clinical presentations of OSA (phenotypes and clusters) with a special focus on our changing
attitudes towards approaches to treatment. Such major efforts are likely to change and expand treatment
options for OSA beyond the most common current choices (i.e. CPAP, mandibular advancement devices,
positional treatment, lifestyle changes or upper airway surgery). More importantly, treatment for OSA may
become more effective, being tailored to each patient's need.