Obstructive sleep apnea: transition from pathophysiology to an integrative disease model

Area of Science:

• Sleep Medicine
• Respiratory Physiology
• Cardiovascular Health

Background:

• Obstructive sleep apnea (OSA) is defined by recurrent upper airway obstruction during sleep.
• The primary issue is the failure of upper airway dilating muscles to counteract negative inspiratory pressures.
• Factors like craniofacial anatomy and neck soft tissue contribute to airway narrowing.

Purpose of the Study:

• To detail the complex pathophysiology of obstructive sleep apnea.
• To explore the bidirectional relationships between OSA and its common comorbidities.
• To highlight the potential for precision medicine in OSA treatment.

Main Methods:

• Review of physiological mechanisms underlying upper airway collapse during sleep.
• Analysis of factors influencing upper airway dilating muscle function.
• Examination of the evidence linking OSA with cardiovascular, metabolic, and neurological conditions.

Main Results:

• Upper airway collapsibility is influenced by anatomical factors, soft tissue, and fluid shifts.
• Genioglossus muscle responsiveness is impaired by sleep onset, ventilatory instability, and loop gain.
• Strong evidence supports bidirectional relationships between OSA and conditions like heart failure, metabolic syndrome, and stroke.

Conclusions:

• A comprehensive understanding of OSA pathophysiology is crucial for developing targeted therapies.
• Identifying pathophysiological endotypes can guide precision medicine approaches.
• Precision medicine may offer alternatives to continuous positive airway pressure (CPAP) for select OSA patients.