title: Future of Sleep-Disordered Breathing Therapy Using a Mechanistic Approach.
abstract: Sleep disordered breathing (SDB) is highly prevalent among patients with cardiovascular disease (CVD), and the relationship between SDB and CVD may be bidirectional. However, SDB remains underdiagnosed and undertreated. One of the major barriers identified by cardiologists is lack of satisfaction with SDB therapy. This situation could be the result of the discordance between treatment and the pathophysiological characteristics of SDB. This condition is caused by multiple pathophysiological mechanisms, which could be classified into upper airway anatomic compromise, pharyngeal dilator muscle dysfunction, and ventilatory control instability. However, the effective treatment of SDB remains limited, and positive airway pressure therapy is still the mainstay of the treatment. Therefore, we review the pathophysiological characteristics of SDB in this article, and we propose to provide individualized treatment of SDB based on the underlying mechanism. This approach requires further study but could potentially improve adherence and success of therapy.
authors.affiliation: Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Pulmonary and Critical Care, University of California, San Diego, La Jolla, California, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jen
authors.affiliation: Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grandner
authors.affiliation: Division of Pulmonary and Critical Care, University of California, San Diego, La Jolla, California, USA. Electronic address: amalhotra@ucsd.edu.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D006801:Humans; D012119:Respiration; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome