The pathogenesis of obstructive sleep apnea

Area of Science:

• Sleep Medicine
• Cardiovascular Health
• Respiratory Physiology

Background:

• Obstructive sleep apnea (OSA) significantly contributes to cardiovascular morbidity and mortality.
• OSA presents a growing challenge to healthcare systems globally.
• Understanding OSA pathogenesis is crucial for developing effective therapeutic strategies.

Purpose of the Study:

• To review current concepts regarding the pathogenesis of obstructive sleep apnea (OSA).
• To present a framework for modeling the biomechanical properties and collapse propensity of the upper airway during sleep.
• To discuss anatomical and neuromuscular factors influencing upper airway obstruction in OSA.

Main Methods:

• Review of current scientific literature on OSA pathogenesis.
• Development of a conceptual model for upper airway biomechanics and collapse.
• Analysis of periodic breathing models and their relation to upper airway obstruction.
• Elaboration of mechanisms linking upper airway obstruction to respiratory pattern destabilization.

Main Results:

• The upper airway plays a primary role in OSA pathogenesis.
• Upper airway obstruction triggers a mismatch between ventilatory supply and demand.
• Trade-offs between sleep stability and ventilation explain OSA severity.
• Recurrent arousals and altered neuromuscular responses modulate OSA expression.

Conclusions:

• Upper airway obstruction is a key driver of OSA.
• Models of respiratory control during sleep can elucidate OSA mechanisms.
• The interplay between sleep stability and ventilation explains the spectrum of OSA.
• Therapeutic strategies may target upper airway patency and respiratory control mechanisms.