Beyond the Mask: The Future of Obstructive Sleep Apnoea Treatment

Real-world efficacy of Continuous Positive Airway Pressure (CPAP) is severely compromised by poor patient tolerance. Despite forty years as the primary intervention, the device remains unpopular and frequently rejected. This operational failure forces a necessary re-evaluation of obstructive sleep apnoea treatment strategies.

Current non-CPAP therapies, including upper airway surgery and oral appliances, typically offer only a 50% reduction in severity. They are inconsistent. This inconsistency stems from a historical misunderstanding of the disease's roots. It is not purely anatomical.

The evolution of obstructive sleep apnoea treatment

Research now isolates non-anatomical drivers. These include impaired pharyngeal muscle function and unstable respiratory control loops. For the 50% of patients battling obesity, new weight-loss drugs address the anatomical predisposition directly. However, for others, the solution may be neurological. The review highlights that ignoring these non-anatomical contributors limits clinical success.

New pharmacotherapy targets are emerging rapidly. These compounds aim to activate pharyngeal dilator muscles or promote deeper, more stable sleep. The data suggests that by stabilising respiratory control, clinicians might prevent airway collapse before it occurs, removing the need for mechanical splinting.

From trial-and-error to precision

The "one-size-fits-all" era is ending. The review outlines a transition to clinical endotyping. This process categorises patients based on specific physiological deficits rather than generic symptoms. By matching therapy to mechanism—using drugs for muscle failure and weight loss for anatomical bulk—clinicians can bypass the current trial-and-error model. This represents a fundamental restructuring of sleep medicine, moving from managing symptoms to targeting causes.