Predictive biomarkers of adequate response to continuous positive airway pressure treatment in sleep apnea: targeting cardiovascular outcomes.

Introduction: The management of obstructive sleep apnea (OSA) based solely on a single metric, the apnea-hypopnea index, constitutes a reductionist approach and has a significant limitation, as it does not adequately capture the multifactorial pathophysiology, phenotypic variability, and clinical heterogeneity of the disease.

Areas covered: The heterogeneity observed in clinical presentations and treatment responses suggests the potential existence of distinct subpopulations in this condition. OSA has been linked to an increased cardiovascular (CV) risk, with continuous positive airway pressure (CPAP) as the primary treatment. However, treatment response varies among patients, highlighting the need for personalized therapeutic approaches. The identification of patients in whom CPAP therapy may mitigate CV risk in OSA could enhance personalized medicine for OSA.

Expert opinion: The objective of this review was to provide a description of various metrics that have been explored in recent years and that may predict CV risk reduction with CPAP therapy. These metrics have been classified into potential molecular biomarkers and biosignals derived from sleep studies. This study describes the predictive role of these biomarkers in the identification of OSA subpopulations that can be protected from CV events using CPAP therapy.