Future Trends in Evaluation and Management of Obstructive Sleep Apnea: Clinical, Polysomnographic, and Phenotyping Approach for a Personalized Treatment

Background: Obstructive sleep apnea syndrome (OSAS) is an increasingly prevalent disorder originating in the upper airway but characterized by profound systemic consequences, particularly cardiovascular and metabolic.Despite decades of research, both diagnosis and management remain controversial.Conventional approaches have largely relied on the apnea-hypopnea index (AHI) and anatomical assessment, leading to heterogeneous outcomes across therapies ranging from positive airway pressure (PAP) to surgery and conservative interventions.Objective: To review the evolution of OSAS assessment and treatment strategies and to highlight emerging trends focused on phenotype-and endotype-guided management.We propose a more rational, personalized, and pathophysiology-driven framework for OSAS care.Design: Narrative review of the literature addressing diagnostic paradigms, treatment limitations, and the role of phenotyping and endotyping in guiding individualized therapy.Conclusions: A precision medicine approach integrating phenotypes and endotypes represents a paradigm shift in OSAS management.By moving beyond single-metric severity classification toward individualized pathophysiological profiling, clinicians can optimize treatment selection, improve adherence, and enhance long-term clinical outcomes.