Sleep apnoea syndrome: how will physiologic knowledge position personalised medicine?

T he sleep apnoea field is no longer only a matter of nocturnal choking and noise-related partner sleep disturbances. There is now a body of literature demonstrating the huge impact of these nocturnal respiratory disturbances on tissular and systemic inflammatory processes, oxidative stress and endothelial dysfunction, as well as imbalance in sympathetic/parasympathetic activities. These factors interact to favour the development of systemic impairments that include alterations in vigilance/cognition, metabolic disturbances, vascular remodelling and atherosclerosis, making way for hypertension, ischaemic heart disease, heart failure, glucose intolerance/diabetes and nonalcoholic steatohepatitis. In the present issue of the European Respiratory Review, the article by LÉVY et al. [1] perfectly illustrates the need for a multi-dimensional approach in the management of this disease by piecing together the up-todate parts of the puzzle represented by the knowledge on pathophysiology, investigations, mechanisms of comorbidity and treatment alternatives. The authors clearly demonstrate that investigating and treating sleep apnoea patients is not only a way to provide silent and quiet nights to patients and their environment, but that the investigation and treatment must be integrated into strategies aimed at preventing the development of comorbid conditions that, nowadays, are recognised as being independently associated with sleep apnoea phenotype. This article also highlights the fact that the mechanisms responsible for the occurrence of sleep apnoea, as well as for the metabolic consequences of the disease, may be individually modulated so that treatment strategies and expected benefits from a sleep apnoea cure may be heterogeneous.