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Phenotyping-based treatment improves obstructive sleep apnea symptoms and severity: a pilot study

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Abstract

Background

Obstructive sleep apnea is a common disorder characterized by multiple pathogenetic roots. Continuous positive airway pressure (CPAP) is almost always prescribed as the first-line treatment to all patients regardless of the heterogeneous pathophysiology, because it mechanically splints the airways open and reduces the collapsibility of the upper airway. Despite its high efficacy, CPAP is burdened by poor adherence and compliance rates. In this pilot study, we treated OSA patients with composite approaches different than CPAP, tailoring the therapeutic choice on OSA phenotypic traits.

Methods

We used the CPAP dial down technique to assess phenotypic traits in eight OSA patients with BMI<35. According to these traits, patients received personalized therapies for 2-week period, after which we ran a second polygraphy to compare apnea-hypopnea index (AHI) before and after therapy.

Results

Two weeks of combined behavioral and pharmacological therapy induced a significant reduction in mean AHI, which dropped from 26 ± 15 at baseline to 9 ± 7 post-treatment (p = 0.01). Furthermore, there was a significant reduction in mean ODI (p = 0.03) and subjective sleepiness (p = 0.01) documented by Epworth Sleepiness Scale (ESS) from baseline to post-treatment recordings.

Conclusions

Treating OSA patients with a personalized combination of pharmacological and behavioral therapies according to phenotypic traits leads to a significant improvement in AHI, ODI, and subjective sleepiness.

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Author contributions

Dr. Messineo contributed to study design, data collection, data analysis and interpretation, and drafting and review of the manuscript for important intellectual content. Dr. Magri contributed to the study design, data collection and interpretation, and drafting and review of the manuscript for important intellectual content. Dr. Corda contributed to data collection and review of the manuscript. Dr. Pini contributed to data collection and review of the manuscript. Dr. Taranto-Montemurro contributed to data analysis and interpretation, and drafting and review of the manuscript for important intellectual content. Dr. Tantucci contributed to the final approval of the version submitted for publication, study design, data analysis and interpretation, and review of the manuscript for important intellectual content

Author information

Correspondence to Ludovico Messineo.

Ethics declarations

Fundings

No funding was received for this research.

Conflict of interests

Luigi Taranto-Montemurro reports personal fees from Novion Pharmaceuticals, outside the submitted work.

The other authors certify that they have no affiliation with or involvement in any organization or entity with any financial interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Comment

This is the first time that the Wellman/Brigham and Women’s/Harvard phenotyping method has been put into clinical practice by another lab. It shows the promise and potential limitations of this approach.

Robert Owens

Boston, USA

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Cite this article

Messineo, L., Magri, R., Corda, L. et al. Phenotyping-based treatment improves obstructive sleep apnea symptoms and severity: a pilot study. Sleep Breath 21, 861–868 (2017). https://doi.org/10.1007/s11325-017-1485-6

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Keywords

  • OSA phenotyping
  • OSA pharmacological therapy
  • OSA behavioral therapy
  • Alternative treatment for sleep apnea