Phenotypic approach to pharmacotherapy in the management of obstructive sleep apnoea

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. 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.