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Upper airway mechanics.

Johan A Verbraecken1, Wilfried A De Backer

  • 1Department of Pulmonary Medicine, Antwerp University Hospital and University of Antwerp, BE-2650 Edegem, Belgium. johan.verbraecken@uza.be

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Summary
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This review explores sleep-disordered breathing, including obstructive sleep apnea and central sleep apnea. Understanding these conditions

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Area of Science:

  • Sleep Medicine
  • Respiratory Physiology
  • Cardiopulmonary Pathophysiology

Background:

  • Sleep-disordered breathing encompasses a spectrum of conditions including obstructive sleep apnea (OSA), central sleep apnea (CSA), Cheyne-Stokes respiration (CSR), and obesity hypoventilation syndrome (OHS).
  • These disorders share common pathophysiological mechanisms contributing to significant morbidity.
  • Current understanding is evolving, with a shift towards viewing central sleep apnea as an obstructive event due to pharyngeal narrowing.

Purpose of the Study:

  • To review the pathophysiological aspects of various sleep-disordered breathing conditions.
  • To highlight the distinct yet interrelated mechanisms underlying these disorders.
  • To discuss the evolving concepts in the pathogenesis of sleep-disordered breathing.

Main Methods:

  • This is a review article, synthesizing existing knowledge on sleep-disordered breathing.
  • Focus is placed on upper airway mechanics and control of breathing instability.
  • Pathophysiological concepts and changing perspectives are discussed.

Main Results:

  • Sleep-disordered breathing involves increased upper airway collapsibility, breathing control instability, and increased work of breathing.
  • Disturbed ventilatory system mechanics and neurohormonal changes are key pathological outcomes.
  • A unifying concept for pathogenesis is still lacking, suggesting a vicious cycle in affected patients.

Conclusions:

  • Sleep-disordered breathing disorders share common underlying mechanisms leading to significant pathology.
  • Evolving concepts, such as viewing CSA as obstructive, are refining our understanding.
  • Identifying common patterns in sleep-disordered breathing is crucial for patient diagnosis and therapeutic guidance.