Towards precision medicine in obstructive sleep apnoea: A meta-analysis linking endotypic traits to disease severity

Abstract Background Obstructive sleep apnoea (OSA) is a heterogeneous disorder with distinct pathophysiological mechanisms. Four identified endotypes contribute to OSA pathophysiology. Despite their critical role, OSA endotypes have not been extensively applied in clinical practice, leading to a non-personalised treatment approach. This study aims to evaluate the correlations between these endotypes and OSA disease severity to guide prognostic stratification and targeted therapies. Methods A comprehensive search across PubMed, Science Direct and Scopus databases was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. Study quality was assessed using the Newcastle-Ottawa scale (NOS). A random-effects meta-analysis was performed to calculate pooled correlation coefficients. Results From 80 retrieved studies, 21 met inclusion criteria, with four reports (n = 1097) eligible for quantitative synthesis. Upper airway collapsibility demonstrated the strongest and most significant correlation with OSA severity (r = 0.323, P < 0.001). Both high loop gain and low arousal threshold showed significant, homogeneous positive correlations (r = 0.264, I 2 = 0%, P < 0.001; and r = 0.250, I 2 = 0%, P < 0.001, respectively). Muscle compensation was not significantly associated (r = 0.040, P = 0.29). Conclusion This meta-analysis delineates that distinct endotypes are significantly correlated with OSA severity. Airway collapsibility emerged as a robust predictor of OSA severity. These findings underscore the clinical utility of pathophysiological endotyping to advance precision medicine in OSA management.