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Stimulating therapy for obstructive sleep apnoea
  1. Patrick J Strollo Jr1,
  2. Atul Malhotra2
  1. 1Deaprtment of Medicine and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Deaprtment of Medicine, University of California San Diego, San Diego, USA
  1. Correspondence to Dr Atul Malhotra, Department of Medicine, University of California San Diego, 9500 Gilman Drive, San Diego 92037, USA; amalhotra{at}ucsd.edu

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The burden of obstructive sleep apnoea (OSA) is increasing due to the worldwide obesity epidemic and the ageing of the population.1 ,2 The treatment of OSA is unsatisfactory for some patients since tolerance of the gold standard treatment positive airway pressure (PAP) is quite variable. Among patients who tolerate PAP, results are excellent; however, effectiveness is limited by variable adherence.3 ,4 Improvements in our understanding of OSA pathogenesis have led to a concept that the mechanism (endotype) underlying OSA is highly variable across individuals such that some patients have primarily an upper airway anatomical problem, whereas others have dysfunction in upper airway dilator muscles, some have unstable control of breathing and some may have combinations of abnormalities.1 This realisation has led to the concept of personalised medicine in OSA such that therapies could theoretically be targeted to the mechanism underlying apnoea rather than using a ‘one-size-fits-all’ approach.5

Efforts to improve treatment are ongoing by developing new therapeutic approaches (eg, hypoglossal nerve stimulation).6 ,7 This approach augments the neural output to upper airway …

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