OSA: a pragmatic clinical algorithm.
| Clinical phase | Key indicators & validated tools | Recommended clinical action | Measurable endpoints & outcomes |
|---|---|---|---|
| 1. Screening | STOP-Bang, Epworth Sleepiness Scale (ESS), clinical history of snoring/apneas. | Refer the patient to diagnostic sleep testing if STOP-Bang ≥ 3, ESS ≥ 10, or if high clinical suspicion exists. | Successful completion and reporting of diagnostic sleep testing (HST or PSG). |
| 2. Diagnosis | Objective Home Sleep Test (HST) or in-laboratory polysomnography (PSG). | Categorize objective OSA severity based on the Apnea-Hypopnea Index (AHI); record oxygen desaturation index (ODI) and nadir SpO2. | Confirmed baseline values for AHI, ODI, and nadir SpO2. |
| 3. Treatment | Baseline OSA severity index, symptom burden, and documented comorbidities. | Initiate auto-adjusting or fixed continuous positive airway pressure (CPAP) therapy; treat concurrent rhinitis/ENT issues; optimize anti-reflux measures; activate a structured weight-loss pathway. | Verified objective CPAP adherence metrics; documented changes in ACT/ACQ scores; percentage of total body weight lost; reduction in AHI. |
| 4. Follow-up | Clinical re-evaluation at 3–6 months post-treatment initiation. | Formally reassess objective asthma control metrics (ACT/ACQ); consider repeating HST if a significant clinical response or major weight shift occurs. | Stabilization or improvement in asthma control scores; objective resolution of sleep-disordered breathing. |
ACT: Asthma Control Test; ACQ: Asthma Control Questionnaire; OSA: obstructive sleep apnea.
During the preparation of this work, the authors used an advanced AI text-generation assistant for structural organization, English language editing, and formatting alignment in response to peer reviewers’ feedback. After utilizing the service, the authors thoroughly reviewed, critically edited, and validated all scientific content, definitions, and medical claims, and take full academic and scientific responsibility for the entire finalized content of the publication.
CL: Conceptualization, Resources, Data curation, Supervision, Validation, Methodology, Writing—original draft, Writing—review & editing. MC: Conceptualization, Resources, Data curation, Methodology, Writing—review & editing. FM: Conceptualization, Resources, Data curation, Methodology, Writing—review & editing. All authors critically reviewed, edited, and approved the final revised version of the manuscript.
Carlo Lombardi, who is the Associate Editor of Exploration of Asthma & Allergy, had no involvement in the decision-making or the review process of this manuscript. The other authors declare no conflicts of interest.
Not applicable. This manuscript is a review article based entirely on previously published literature and public aggregated data. It does not involve any primary research, new clinical trials, or direct experimentation on human participants or animal subjects.
Not applicable. This study does not report on primary data collection derived from individual human subjects, and no primary clinical interventions were performed.
Not applicable. This review contains no individual patient clinical details, identifying case descriptions, or personal media/images requiring specific individual publication consent.
All data generated or analyzed during this review are included within this published article and its accompanying tables. The sources cited and synthesized are fully traceable through the provided bibliography list.
The authors received no specific grant or financial funding from any public, commercial, or non-profit sector sponsor for the research, authorship, or publication of this review article.
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