Could pathophysiology-driven and combination therapies shape future CSA care and AASM guidelines?

I think the future is individualized therapy based on pathophysiology. And, for example, none of the treatments that you see is actually pathophysiology-driven to the genesis of central apnea. All the positive pressure therapies are repurposed from OSA treatment. It’s positive pressure with a twist, either CPAP or ASV or BPAP. We’re just simply varying how we deliver the pressure. So they’re actually borrowed therapy from another condition. Oxygen and acetazolamide, kind of after the fact, they’re dealing with some of the consequences of some of the things that perpetuate it. For example, acetazolamide lowers the plant gain. Supplemental oxygen lowers controller gain. And may, to some extent, touch also on the plant gain. So both of them work on some of the destabilizing or the perpetuating factors. Really, the only treatment right now that goes to the genesis of the condition is phrenic nerve stimulation. But again, as I said, it’s usually a secondary treatment because it requires specialized centers. I think the future will be in looking at agents or interventions that target the genesis of central apnea. Go to the medullary level and say, why is it that we’re turning off respiration? That’s one. The second one is combination therapy. Sleep apnea, especially central apnea. Is a chronic condition that we insist on treating it with a single agent. Name one chronic medical condition, maybe other than hypothyroidism, where we treat it with a single agent. Combined therapy is the wave of the future. And I would personally, I’m an advocate of the idea of starting to explore combined therapies. For example, CPAP to eliminate the obstructive events that keep the upper airway patent and then an intervention to stabilize respiration and agent. There are not enough literature on this area, but I think this potentially could be a future path. I think the guidelines will evolve. Usually they’re reviewed every five to 10 years. And as new interventions appear as new therapies, and I’m talking here about the idea of precision medicine or individualized medicine, or actually the way I’d like to think it is pathophysiology-driven interventions. As we move into linking the pathophysiology, the pathogenesis to central apnea. I think there will be new therapies that will emerge and the guidelines will reflect that they will be incorporated in it because this is something that’s periodically reviewed and we will include it into our own armamentarium of interventions. All of this will take time and it will require clinical trials and it will require comparative effectiveness among different therapies. But I think this is the future pathophysiology-driven that we can test and incorporate into future guidelines.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.