S18: Update on Obstructive Sleep Apnoea and Central Sleep Apnoea Management Strategies

Toward Personalised Non-PAP Therapy for Obstructive Sleep Apnoea While positive airway pressure (PAP) remains the gold standard treatment for obstructive sleep apnoea (OSA), long-term compliance is frequently limited by patient intolerance. Emerging insights into the pathophysiology of OSA reveal that the condition is not solely driven by anatomical airway collapse; rather, it is governed by four distinct endotypes that include three non-anatomical endotypes such as poor upper airway muscle responsiveness, low respiratory arousal threshold, and high loop gain (ventilatory control instability). This paradigm shift paves the way for precision medicine and targeted, non-PAP therapeutic strategies tailored to individual physiological profiles. This lecture will review recent advances in non-PAP therapeutic modalities mapped to specific OSA endotypes, examine clinical trial evidence, and address current challenges and future directions in clinical phenotyping and personalized care. Strategies include anti-obesity interventions such as dual GIP/GLP-1 receptor agonists and structural stabilization through hypoglossal or ansa cervicalis nerve stimulation, pharmacological neuromuscular stabilization, loop gain modulation and arousal threshold management. Personalising non-PAP therapy based on individual pathophysiological traits offers a promising paradigm for patients who refuse or are intolerant to PAP. Future clinical success relies on validating automated computational phenotyping tools within routine diagnostic workflows, standardizing prediction thresholds across diverse global populations, and establishing outcome-focused trials linked to hard clinical endpoint.