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Established therapies such as continuous positive airway pressure (CPAP) and oral appliance therapy (OAT) work chiefly through targeting elevated collapsibility, which affects the majority of OSA patients. However, many patients respond poorly or do not tolerate these \u2018anatomic\u2019 therapies. The emerging field of \u2018precision sleep medicine\u2019 seeks to determine if novel treatment approaches specifically targeting the other, \u2018non\u2010anatomic\u2019 mechanisms will improve treatment efficacy and acceptance. In this review, we consider the concepts underlying each pathophysiologic mechanism, the predisposing factors, and the potential implications for established and future OSA treatments.<\/jats:p>","DOI":"10.1111\/adj.13060","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T17:11:41Z","timestamp":1741713101000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["<scp>OSA<\/scp>\n                    pathophysiology: a contemporary update"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2275-8192","authenticated-orcid":false,"given":"TM","family":"Tolbert","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine Icahn School of Medicine at Mount Sinai  New York New York 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