title: Phenotyping-based treatment improves obstructive sleep apnea symptoms and severity: a pilot study.
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.
authors.affiliation: Respiratory Medicine and Sleep Laboratory, Department of Experimental and Clinical Sciences, University of Brescia and Spedali Civili, Piazzale Spedali Civili 1, 25000, Brescia, Italy. ludovico.messineo@yahoo.it.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Messineo
authors.affiliation: Respiratory Medicine and Sleep Laboratory, Department of Experimental and Clinical Sciences, University of Brescia and Spedali Civili, Piazzale Spedali Civili 1, 25000, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Magri
authors.affiliation: Respiratory Medicine and Sleep Laboratory, Department of Experimental and Clinical Sciences, University of Brescia and Spedali Civili, Piazzale Spedali Civili 1, 25000, Brescia, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Corda
authors.affiliation: Respiratory Medicine and Sleep Laboratory, Department of Experimental and Clinical Sciences, University of Brescia and Spedali Civili, Piazzale Spedali Civili 1, 25000, Brescia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pini
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Taranto-Montemurro
authors.affiliation: Respiratory Medicine and Sleep Laboratory, Department of Experimental and Clinical Sciences, University of Brescia and Spedali Civili, Piazzale Spedali Civili 1, 25000, Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tantucci
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy; D004038:Diet, Reducing; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010641:Phenotype; D010865:Pilot Projects; D057285:Precision Medicine / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000178:diet therapy / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*
keywords: Alternative treatment for sleep apnea; OSA behavioral therapy; OSA pharmacological therapy; OSA phenotyping