Precision medicine in OSA Management

Naricha Chirakalwasan
Chulalongkorn University, Bangkok, Thailand

The knowledge on obstructive sleep apnea (OSA) has advanced during the past decade with understanding of underlying pathophysiology so called endotype. OSA endotype can be divided into anatomical trait (increased airway collapsibility) and non-anatomical trait (low arousal threshold, high loop gain, and poor muscle responsiveness). The OSA phenotype based on symptoms, clinical demographics, and polysomnographic characteristics also have been studied. Multidimensional phenotypes, integrating symptoms, anthropometry, polysomnography parameters, and craniofacial morphology have shown promise in improving prognostication, tailoring therapy, and guiding patient selection for specific treatment. Recent studies demonstrated that AHI may not be the best metric for OSA risk stratification. Therapeutic implications are increasingly evident in specific phenotypes i.e. excessively sleepy patients and/or severe oxygen desaturation subgroups may experience the greatest cardiovascular benefit from positive airway pressure therapy. This emerging new evidence offers critical insights into disease mechanisms and targets for intervention.

Reference

• Suwannakin A, Reutrakul S, Chirakalwasan, N.  Does glucose metabolism and its consequences depend on the phenotype of obstructive sleep apnea? Curr Opin Pulm Med. 2025 (In Press).
• Edwards BA, Jordan AS, Schmickl CN, et al. POINT:: Are OSA Phenotypes Clinically Useful? Yes. Chest. 2023 ;163(1):25-8.
• Zinchuk A, Yaggi HK. Phenotypic Subtypes of OSA: A Challenge and Opportunity for Precision Medicine. Chest. 2020;157(2):403-20.