Sleep apnoea: what are the challenges for tomorrow?

Abstract

Since the late 1980s and early 1990s sleep-related breathing disorders (SRBD) have been extensively described. Many studies have been performed to understand their pathophysiological mechanisms, treatment modalities and clinical consequences. These studies have been described in many papers but also in excellent reviews and monographs, including the recently published ERS Handbook: Respiratory Medicine [1–4]. Distinction was made between sleep apnoea mainly due to upper airway collapse, obstructive apnoea (OA), and sleep apnoea caused by irregular breathing patterns, central apnoeas and Cheyne–Stokes respiration [5]. Both presentations are however also interrelated. Unstable breathing pattern, which can be seen as a starting point, can indeed lead to central apnoeas but in the case of increased upper airway collapsibility also to mixed apnoeas and obstructive apnoeas with almost no detectable central component. Today, we know that SRBD have a huge impact on society, since they can lead to many complications, including cardiovascular and metabolic ones [6–9]. Increased fatigue and daytime sleepiness are important causes of attention deficits leading to accidents at work and to car accidents [10]. Nasal CPAP (nCPAP) has been demonstrated to be highly effective …