Changing paradigm of managing sleep disordered breathing

Nur Hashima Abdul Rashid
Prince Court Medical Centre, Kuala Lumpur, Malaysia

The management of sleep-disordered breathing (SDB) is evolving from a standardized, apnea–hypopnea index (AHI)-based framework to a more sophisticated, patient-centred approach. Traditionally dominated by obstructive sleep apnea (OSA) and reliant on in-lab polysomnography and CPAP therapy, the old model often failed to address the diverse mechanisms, clinical presentations, and health consequences of SDB. The emerging paradigm recognizes SDB as a spectrum influenced by epigenetics, behavioural patterns, and lifestyle habits—shaped across the lifespan, from the womb to the tomb—while accounting for each individual’s unique adaptations and compensatory mechanisms. Modern management emphasizes individualized care, guided by phenotyping and endotyping—such as upper airway collapsibility, ventilatory control instability, and arousal threshold. Treatment has expanded beyond CPAP to include paediatric oral health, oral appliances, upper airway stimulation, adaptive servo-ventilation, bodywork, and pharmacologic options targeting underlying mechanisms. Multidisciplinary care models are evolving into truly interdisciplinary approaches—integrating pulmonologists, ENT specialists, cardiologists, neurologists, dentists, and behavioural health professionals—fostering deeper collaboration and shared understanding across specialties to address the systemic impacts of sleep-disordered breathing (SDB) across the lifespan, from childhood through adulthood to old age. Technological innovations, including home sleep testing, wearables, and remote monitoring, support early detection and personalized treatment adjustments. This shift in paradigm reframes SDB as a chronic, multifactorial disorder requiring long-term, holistic management. It aims to enhance adherence, improve quality of life, and reduce the broader public health burden associated with untreated SDB.