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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}

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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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  • Competing interests PJS is a co-investigator on RO1 DK096028-02, RO1 HL120354-01A1, 1UH2HL125103-01, U01HL128954 and 5UL1TR000005-09. He has research grants from Philips Respironics, ResMed, Inspire Medical Systems and Jazz Pharmaceuticals. He has received consulting fees from Inspire Medical Systems, ResMed, Emmi Solutions, Jazz Pharmaceuticals, Itamar Medical and the National Football League. AM is PI on NIH RO1 HL085188 and K24 HL132105 and co-investigator on R21 HL121794, RO1 HL 119201 and RO1 HL081823. As an Officer of the American Thoracic Society, AM has relinquished all outside personal income since 2012. ResMed provided a philanthropic donation to the University of California, San Diego in support of a sleep centre, which AM's division runs.

  • Provenance and peer review Commissioned; externally peer reviewed.

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