Obstructive sleep apnoea pathogenesis from mild to severe: Is it all the same?

Area of Science:

• Sleep Medicine
• Respiratory Physiology
• Otolaryngology

Background:

• Obstructive sleep apnoea (OSA) is a prevalent condition linked to upper airway compromise.
• Both anatomical (narrow airways) and non-anatomical factors contribute to OSA pathogenesis.
• Understanding these factors' relationship with disease severity is crucial for effective management.

Purpose of the Study:

• To review and synthesize current knowledge on pathological factors causing OSA.
• To examine how these factors correlate with OSA severity, measured by the apnoea-hypopnoea index (AHI).
• To explore the implications of factor variability on treatment outcomes.

Main Methods:

• Systematic literature review of studies investigating OSA pathophysiology.
• Analysis of how anatomical and non-anatomical OSA contributors vary across different AHI categories.
• Synthesis of findings to identify patterns and heterogeneity in contributing factors.

Main Results:

• Most key factors contributing to OSA demonstrate variation with disease severity.
• Significant heterogeneity exists, with individual factor contributions differing between patients and across disease severities.
• The interplay of these factors is complex and not uniform.

Conclusions:

• The variability in OSA-causing factors contributes to the diverse efficacy of non-continuous positive airway pressure (CPAP) treatments.
• Inconsistent patient responses to treatments across different baseline OSA severities are likely related to this heterogeneity.
• Personalized treatment strategies may be necessary to address the multifactorial nature of OSA.