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Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature

1
Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
2
Adelaide Institute for Sleep Health, Flinders University, Adelaide 5001, Australia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1846; https://doi.org/10.3390/jcm8111846
Received: 11 October 2019 / Revised: 29 October 2019 / Accepted: 30 October 2019 / Published: 2 November 2019
Obstructive sleep apnea (OSA) is a highly prevalent condition with few therapeutic options. To date there is no approved pharmacotherapy for this disorder, but several attempts have been made in the past and are currently ongoing to find one. The recent identification of multiple endotypes underlying this disorder has oriented the pharmacological research towards tailored therapies targeting specific pathophysiological traits that contribute differently to cause OSA in each patient. In this review we retrospectively analyze the literature on OSA pharmacotherapy dividing the medications tested on the basis of the four main endotypes: anatomy, upper airway muscle activity, arousal threshold and ventilatory instability (loop gain). We show how recently introduced drugs for weight loss that modify upper airway anatomy may play an important role in the management of OSA in the near future, and promising results have been obtained with drugs that increase upper airway muscle activity during sleep and reduce loop gain. The lack of a medication that can effectively increase the arousal threshold makes this strategy less encouraging, although recent studies have shown that the use of certain sedatives do not worsen OSA severity and could actually improve patients’ sleep quality. View Full-Text
Keywords: OSA phenotypes; OSA endotypes; OSA pharmacotherapy; precision medicine OSA phenotypes; OSA endotypes; OSA pharmacotherapy; precision medicine
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Taranto-Montemurro, L.; Messineo, L.; Wellman, A. Targeting Endotypic Traits with Medications for the Pharmacological Treatment of Obstructive Sleep Apnea. A Review of the Current Literature. J. Clin. Med. 2019, 8, 1846.

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