Recent advances and emerging insights in obstructive sleep apnea: implications for diagnosis and cardiovascular risk assessment

Obstructive sleep apnea (OSA) is a sleep-breathing disorder with repetitive total or partial airway occlusion events. Its importance lies in the high prevalence and presence in all age groups and on cardiovascular (CV), metabolism, neurocognitive function, mental health, and overall quality of life. Furthermore, the coexistence of multiple comorbidities in patients suffering from OSA plays an essential role in these entities' development, perpetuation, and clinical control. In the past years, efforts have been made to understand the pathophysiology of each event, the spectrum of the disease, and the different phenotypes, as well as to refine the diagnostic process and, thus, direct treatment toward a more comprehensive and personalized approach. Many uncertainties remain regarding which patients are at higher CV risk and who derive the greatest benefit from treatment. In this promising scenario, new tools have been developed, including advanced diagnostic technologies, molecular biomarkers, and predictive statistic models tailored for precision medicine. However, to effectively understand and manage this heterogeneous and complex pathology, well-designed studies are essential to validate precision medicine models and ensure their efficient integration into routine clinical practice in a simple, accessible, and practical manner. In this article, we present a comprehensive review of the most relevant scientific evidence concerning the diagnosis and treatment of OSA. We examine significant cluster studies available to date and aim to provide the reader with personalized recommendations for diagnosing and treating OSA. Additionally, we propose new pathways for advancing precision medicine in the field of sleep-disordered breathing.