Integrative treatment of obstructive sleep apnea: principles and practice.

In the management of obstructive sleep apnea, the integrative concept of care is gathering momentum. This is an encouraging development to prevent deficiencies or errors due to a lack of professional collaboration since risks, benefits and alternatives of various techniques can be discussed candidly. However, while the deployment of a multidisciplinary team is encouraged, a scientific, evidence-based approach needs to be rigorously engendered to encompass the phenotypic heterogeneity of obstructive sleep apnea, including neurologic, metabolic, craniofacial, and myopathic endotypes. This classification helps identify diverse techniques for screening, diagnostics, treatment, and long-term follow-up, while recognizing underlying principles of management, such as the critical airway collapsing pressure, arousal threshold, loop gain, and muscle tone classification. For example, in the craniofacial endotype, recognizing developmental compensation, postural compensation, and decompensation will aid in case selection and indicate the most appropriate treatment protocol to help with clinical, interdisciplinary decision-making and management of obstructive sleep apnea. In fact, emerging techniques indicated to achieve future directions and goals of an integrated approach include the use of novel algorithms, artificial intelligence, and pharmaceuticals for data-driven predictive modeling. CITATION: Singh GD, Battle J. Integrative treatment of obstructive sleep apnea: principles and practice.