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Pépin JL, Attias D, Baillieul S, Ben Messaoud R, Bequignon E, Gagnadoux F, Gentina T, Heinzer R, Patout M, Perrin C, Piau A, Trzepizur W, Micoulaud-Franchi JA, Tamisier R, Zarqane N, Pathak A. A multidisciplinary approach to the home management of continuous positive airway pressure therapy for obstructive sleep apnea: beyond usual care pathways (a narrative review). Sleep Med 2025; 131:106522. [PMID: 40279979 DOI: 10.1016/j.sleep.2025.106522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Revised: 03/25/2025] [Accepted: 04/15/2025] [Indexed: 04/29/2025]
Abstract
Obstructive sleep apnea (OSA) is a common chronic condition that is growing in prevalence, associated with important comorbidities, and has several different phenotypes. Continuous positive airway pressure (CPAP) is the gold standard OSA treatment, but its effectiveness relies on consistent adherence, which can often be difficult to maintain. This narrative review discusses current challenges in the care pathways for CPAP therapy management in OSA, including fragmented care/lack of continuity, inadequate management of comorbidities, suboptimal implementation of digital medicine solutions, and existing reimbursement paradigms. Key tasks to be shared between the appropriate healthcare professionals and providers include technical CPAP follow-up (adherence, effectiveness, alert management), management of comorbidities, and multimodal non-invasive monitoring. What this looks like and who provides the different aspects of care should vary by OSA phenotype, ranging from simple follow-up in primary care (uncomplicated OSA with good CPAP adherence) to multidisciplinary specialist management (high-risk OSA with comorbidities), with regular reassessment to ensure continued alignment with the chosen care plan. In addition to better defining these pathways, how they are reimbursed also needs to be addressed. We suggest that there should be a multidisciplinary approach to symptom reduction and adherence, longitudinal assessment of patient-reported outcomes, and a focus on long-term cardiometabolic health as part of managing CPAP-treated patients with OSA. Facilitated by the appropriate use of digital technologies, these approaches should lead to more personalized care and greater patient engagement, resulting in better long-term adherence and treatment effectiveness. The ultimate goal should be to do better for less.
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Affiliation(s)
- Jean-Louis Pépin
- University Grenoble-Alpes and HP2 Laboratory, INSERM, La Tronche, France.
| | - David Attias
- Department of Pulmonary and Sleep Medicine, Clinique Pasteur, Toulouse, France
| | | | - Raoua Ben Messaoud
- University Grenoble-Alpes and HP2 Laboratory, INSERM, La Tronche, France
| | - Emilie Bequignon
- Department of ENT, Head and Neck Surgery, Créteil Intercommunal Hospital and Henri Mondor University Hospital, Public Assistance - Paris Hospitals, Créteil, France
| | - Frédéric Gagnadoux
- Angers University Hospital, Angers, France; INSERM Unit 1063, Angers, France
| | - Thibaut Gentina
- Ramsey General Healthcare La Louviere Hospital, Lille, France
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Maxime Patout
- Inserm UMRS1158 Experimental and Clinical Respiratory Neurophysiology, Sorbonne University, Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, FHU UMANHYS, Service des Pathologies du Sommeil (Département R3S, Paris, France
| | | | - Antoine Piau
- CERPOP, INSERM, Université Toulouse 3, Toulouse, France; IHU HealthAge, University Hospital of Toulouse, Toulouse, France; Medical, Ethics and Innovation Department, Clariane Group, Paris, France
| | - Wojciech Trzepizur
- Angers University Hospital, Angers, France; INSERM Unit 1063, Angers, France
| | - Jean-Arthur Micoulaud-Franchi
- University of Bordeaux, CNRS, SANPSY, UMR, 6033, Bordeaux, France; Department of Sleep Medicine, University Hospital of Bordeaux, Bordeaux, France
| | - Renaud Tamisier
- University Grenoble-Alpes and HP2 Laboratory, INSERM, La Tronche, France
| | - Naima Zarqane
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco; INI-CRCT (Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists) Network, Nancy, France
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Kundel V, Ahn A, Arzt M, Asin J, Azarbarzin A, Collop N, Das A, Fang JC, Khayat R, Penzel T, Pépin JL, Sharma S, Suurna MV, Tallavajhula S, Malhotra A. Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel. J Clin Sleep Med 2025; 21:405-416. [PMID: 39385622 PMCID: PMC11789259 DOI: 10.5664/jcsm.11424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 10/03/2024] [Accepted: 10/03/2024] [Indexed: 10/12/2024]
Abstract
Central sleep apnea (CSA) is commonly encountered among patients with sleep-disordered breathing; however, its clinical consequences are less well-characterized. The senior author (A.M.) therefore convened an expert panel to discuss the common presentations of CSA, as well as challenges and knowledge gaps in the diagnosis and management of CSA. The panel identified several key research priorities essential for advancing our understanding of the disorder. Within the diagnostic realm, panel members discussed the utility of multinight assessments and importance of the development and validation of novel metrics and automated assessments for differentiating central vs obstructive hypopneas, such that their impact on clinical outcomes and management may be better evaluated. The panel also discussed the current therapeutic landscape for the management of CSA and agreed that therapies should primarily aim to alleviate sleep-related symptoms, after optimizing treatment to address the underlying cause. Most importantly, the panel concluded that there is a need to further investigate the clinical consequences of CSA, as well as the implications of therapy on clinical outcomes, particularly among those who are asymptomatic. Future research should focus on endo-phenotyping central events for a better mechanistic understanding of the disease, validating novel diagnostic methods for implementation in routine clinical practice, as well as the use of combination therapy and comparative effectiveness trials in elucidating the most efficacious interventions for managing CSA. CITATION Kundel V, Ahn A, Arzt M, et al. Insights, recommendations, and research priorities for central sleep apnea: report from an expert panel. J Clin Sleep Med. 2025;21(2):405-416.
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Affiliation(s)
- Vaishnavi Kundel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anjali Ahn
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Jerryll Asin
- Department of Pulmonary Medicine and Center for Sleep Medicine, Amphia Hospital, Breda, The Netherlands
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy Collop
- Emory Sleep Center, Emory University, Atlanta, Georgia
| | - Aneesa Das
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - James C. Fang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Rami Khayat
- University of California-Irvine Comprehensive Sleep Center, Irvine, California
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité University Hospital, Berlin, Germany
| | - Jean-Louis Pépin
- University Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2 Laboratory, Grenoble, France
| | - Sunil Sharma
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Maria V. Suurna
- Otolaryngology-Head and Neck Surgery, University of Miami Health System, Miami, Florida
| | - Sudha Tallavajhula
- Department of Neurology, Epilepsy Division, University of Texas Health Sciences Center, Houston, Texas
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, San Diego, California
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