Upper airway homeostasis: A review

Several approaches have been developed to treat sleep disordered breathing, specifically obstructive sleep apnea (OSA) but most of these techniques involve biomechanical manipulation of the upper airway without necessarily addressing the notion of upper airway homeostasis (UAH). For example, continuous positive airway pressure acts as a successful pneumatic splint but is hindered by relatively low patient compliance. Oral appliance therapy has improved adherence, but it is typically limited to mild to moderate cases of OSA. Surgical electro-stimulation procedures have also been advocated, but they may not address hypopharyngeal hypotonia. Oral myofunctional therapy has also been suggested, but it is a patient-intensive protocol, which is successful in selected cases. In addition, other disparate approaches, including pharmaceuticals, have been shown to have therapeutic benefits in the management of OSA. However, none of these approaches directly addresses intrinsic UAH. Therefore, the aim of this article is to review UAH and propose it as a framework for future research endeavors in the development of physiologically based therapies for OSA.