Longitudinal Management and a Decision-Aid Tool in Treatment-Resistant Sleep Apnea

Purpose of ReviewWe expect an increased pressure of treating residual sleepiness in parallel with the introduction of novel wakefulness-promoting drugs to the European market. Our purpose is to review the literature on longitudinal management of treatment-resistant obstructive sleep apnea (OSA) and on this background to propose a management plan for this patient group focusing on both reduction of cardiovascular risk and relief of symptoms.Recent FindingsMost OSA literature focuses on primary diagnostics and primary or secondary treatment options in unstratified clinical populations. In this review, we focus on longitudinal management of treatment-resistant OSA described in recent, key publications. Moreover, we identified future diagnostic trends that also may be of clinical importance in this patient group. Finally, based on this background, we propose a standardized approach to secondary diagnostics and treatment decisions in treatment-resistant OSA based on a novel decision-aid tool.Limited literature was found on the longitudinal aspects of OSA treatment. Based on this background, a standardized management plan for treatment-resistant OSA and a shared decision-aid tool is proposed. The management plan focuses on both stabilization of the upper airway and relief of symptoms.