A scoping review of clinical approach and personalized management of obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) is common yet frequently underdiagnosed. It not only impairs the sleep quality but also associated with multiple comorbidities. This review article aims at providing an update on the diagnosis and management of OSA through a personalized approach. The prevalence of OSA is more in males than premenopausal females (almost 3:1–5:1) and this equalises after menopause. History taking in OSA should focus not only on symptoms such as snoring, choking, dryness of mouth, and daytime somnolence but also on comorbidities. Various options and levels of polysomnography are currently available and newer options being explored to make OSA assessment more simpler, accessible, and feasible. Traditional approach included assessment of oropharyngeal anatomy, pulmonary system, and anthropometry. Alternatively, personalized approach involves scoring based on Pcrit, Arousal threshold, Loop gain and Muscle responsiveness (PALM Scale) scale and offering customized options for the management. In addition to newer modalities in surgical approach to OSA, promising results have been noted with medical therapy with Solriamfetol and Dronabinol. OSA in children has been linked with various comorbidities and is notably different from adult OSA. With the increasing literature on various endophenotypes of OSA, the onus is on the physician to evaluate the patient and categorize appropriately for personalized treatment.

Keywords

• comorbidities
• endotypes
• management
• obstructive sleep apnea
• personalized approach