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Obstructive Sleep Apnoea: Focus on Pathophysiology.

Walter T McNicholas¹

¹School of Medicine, University College Dublin, Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland. walter.mcnicholas@ucd.ie.

Advances in Experimental Medicine and Biology

|October 10, 2022

Summary

This summary is machine-generated.

Obstructive sleep apnoea (OSA) involves upper airway collapse during sleep due to muscle dysfunction. Understanding OSA

Keywords:

Arousal Endotype Obstructive sleep apnoea Pathophysiology Treatment Upper airway anatomy Ventilatory control

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Area of Science:

Sleep Medicine
Respiratory Physiology
Otolaryngology

Background:

Obstructive sleep apnoea (OSA) is defined by recurrent upper airway obstruction during sleep.
The primary issue in OSA is the failure of upper airway dilating muscles to counteract negative inspiratory pressures.
Factors like craniofacial anatomy, neck soft tissue, and fluid shifts exacerbate airway narrowing and collapse.

Purpose of the Study:

To explore the complex pathophysiology of obstructive sleep apnoea.
To highlight the role of upper airway dilating muscle function and its modulators in OSA.
To advocate for precision medicine approaches in OSA treatment.

Main Methods:

Review of existing literature on OSA pathophysiology.
Analysis of factors influencing upper airway dilating muscle function (e.g., genioglossus).
Consideration of sleep onset, ventilatory instability, and loop gain effects.

Main Results:

Upper airway collapsibility is influenced by anatomical and physiological factors.
Genioglossus muscle responsiveness is impaired by sleep, ventilatory instability, and high loop gain.
Evidence suggests the existence of multiple endotypes within OSA patients.

Conclusions:

A comprehensive understanding of OSA pathophysiology is crucial for developing targeted therapies.
Identifying distinct pathophysiological endotypes can guide treatment strategies.
Precision medicine offers a potential alternative to CPAP for selected OSA patients.