A Novel Paradigm for Precision Interdisciplinary Management of Obstructive Sleep Apnea: From Childhood to Adulthood

Abstract Background: Obstructive sleep apnea (OSA) is a prevalent disorder traditionally managed in specialty silos, with adenotonsillectomy (AT) for children and continuous positive airway pressure (CPAP) for adults, often yielding suboptimal outcomes. This systematic narrative review proposes a novel three-pillar interdisciplinary precision framework integrating phenotype-targeted interventions across the lifespan. Methods: A systematic literature search of PubMed, Cochrane Library, and Google Scholar was conducted (January 1993 – December 2024). Inclusion criteria comprised clinical trials, systematic reviews, and clinical practice guidelines. A PRISMA 2020-style flow diagram (Supplementary Figure 1) documented the screening process. Methodological quality was assessed using Cochrane RoB, AMSTAR-2, AGREE II, and the Newcastle-Ottawa Scale, with results summarized in Table 2. Results: From 215 identified records, 45 studies met inclusion criteria (complete list in Supplementary Table S1). Synthesis demonstrates superior apnea-hypopnea index (AHI) reductions from combined AT and rapid maxillary expansion (RME) in phenotype-defined children, and validates oral appliances and positional therapy in adults with specific phenotypes. Table 1 summarizes the 67 full-text assessed studies by category, and Table 3 provides a comprehensive multidisciplinary phenotyping framework. Conclusions: This three-pillar framework establishes dentists/orthodontists as lifelong collaborators within a unifying endotype-driven model. This conceptual shift promises improved therapeutic precision and outcomes by matching treatment to individual pathophysiology through interdisciplinary collaboration. A practical decision algorithm for clinical implementation is provided in Appendix A.