Reena Mehra, MD: Biomarkers and Endophenotypes for Personalized Patient Care

Sleep studies provide a wealth of physiological information that can advance many aspects of clinical practice. In an interview at SLEEP 2023, Reena Mehra, MD, MS, director and professor of medicine at the Sleep Disorders Center, Cleveland Clinic, highlighted the potential offered by endophenotypes yielded from sleep studies in predicting clinical outcomes, including conditions like atrial fibrillation (AF).

"It can be helpful in terms of screening, in terms of prediction of outcomes which helps you then risk stratify populations, and also for treatment responsiveness," she said. "So, these biomarkers from the sleep studies can be useful to us in a variety of ways."

Much of sleep apnea treatment is focused on managing patient symptoms. In recent years, the field of endophenotyping has garnered significant attention, signaling a growing recognition of the need to move beyond simplistic measures.

"Integrating (clinical symptom management) with the objective data that you get from a sleep study is important," she explained.

Mehra and her team from the Cleveland Clinic received a Discovery Accelerator Award which will allow them to collaborate with IBM to further examine how different facets of sleep apnea pathophysiology contribute to AF. CPAP therapy is the first-line treatment, but the optimal option depends on the individual.

Advancements had led to additional treatment avenues like hypoglossal nerve stimulation and oral appliances and Mehra shared her motivation to find a way to determine which specific treatment strategy is best for each patient.

"I think there's opportunity to look at it more, or even doing cluster analyses where you can see if there are groupings of symptoms, and polysomnographic findings, endophenotypes, from the sleep studies–that when you take them together-do a better job of figuring out who's going to derive benefit from maybe a specific therapy."