P4 medicine approach to obstructive sleep apnoea

Abstract

P4 medicine is an evolving approach to personalized medicine. The four Ps offer a means to: Predict who will develop disease and co-morbidities; Prevent rather than react to disease; Personalize diagnosis and treatment; have patients Participate in their own care. P4 medicine is very applicable to obstructive sleep apnoea (OSA) because each OSA patient has a different pathway to disease and its consequences. OSA has both structural and physiological mechanisms with different clinical subgroups, different molecular profiles and different consequences. This may explain why there are different responses to alternative therapies, such as intraoral devices and hypoglossal nerve stimulation therapy. Currently, technology facilitates patients to participate in their own care from screening for OSA (snoring and apnoea apps) to monitoring response to therapy (sleep monitoring, blood pressure, oxygen saturation and heart rate) as well as monitoring their own continuous positive airway pressure (CPAP) compliance. We present a conceptual framework that provides the basis for a new, P4 medicine approach to OSA and should be considered more in depth: predict and prevent those at high risk for OSA and consequences, personalize the diagnosis and treatment of OSA and build in patient participation to manage OSA.

Keywords: continuous positive airway pressure; intraoral devices; obesity; obstructive sleep apnoea; precision medicine.

Figure 1:

The Determinants of Individual Differences is composed of many Individual Characteristics and Environmental Factors. These many individual determinants can be analysed into many types of Manifestations of Individual Differences. Collectively, the determinants of individual differences and the manifestation of individual differences should determine an OSA classification schema that predicts clinical consequences. As we collect extensive raw data on individuals with OSA and perform predictive analytics on this raw data, a new OSA classification schema e.g. “how severe is my OSA?” would be able to predict an individual’s clinical consequences e.g. “what does this mean to me?”