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Pathophysiology of Obstructive Sleep Apnea (OSA)

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Management of Obstructive Sleep Apnea

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Abstract

Prior to 1978, investigations related to obstructive sleep apnea pathogenesis focused on obesity-hypoventilation syndrome (OHS). At the time, OHS was a disorder associated with many theories of pathogenesis, but there was little strong support for any of them. In the mid- to early 1960s, Gastaut et al. were the first to describe obstructive sleep apnea in these patients [16, 17], and over the ensuing years multiple reports appeared demonstrating the successful reversal of OHS after treatment of obstructive sleep apnea [50, 51, 66]. (Hereafter, OSA will be used to represent the entire spectrum of sleep-related obstructive events: apneas, hypopneas, and respiratory effort-related arousals.) A landmark study published in 1978 by Remmers et al., demonstrated that OSA events were accompanied by a closed upper airway and that negative pharyngeal pressure behind the tongue prevented forward tongue movement causing, in essence, asphyxia. This continued until an arousal-mediated recruitment of the airway dilator muscles opened the airway, with a surge in anterograde tongue activity associated with the arousal [52]. These findings changed the focus of physiology research to examine the pathogenesis of OSA with or without OHS: to attempt to understand why the pharynx is narrowed, how this affects the flow of air, circumstances of activation of pharyngeal muscles, and mechanism of arousals [73].

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Conflict of Interest

Dr. Ralls has no conflicts to declare.

Dr. Cutchen has no conflicts to declare.

Dr. Brown has participated in advisory panels for Philips Respironics and has been an insurance claims reviewer for Considine and Associates, Inc. He co-edits the sleep and respiratory neurobiology section of Current Opinion in Pulmonary Medicine and wrote on CPAP treatment for obstructive sleep apnea in UpToDate and on obstructive sleep apnea in Clinical Decision Support: Pulmonary Medicine and Sleep Disorders. He is co-edited an issue of Sleep Medicine Clinics on positive airway pressure therapy. He serves on the Polysomnography Practice Advisory Committee of the New Mexico Medical Board and chairs the New Mexico Respiratory Care Advisory Board.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Frank Ralls, Lisa Cutchen & Lee K. Brown

  2. Program in Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

    Frank Ralls, Lisa Cutchen & Lee K. Brown

  3. Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, Albuquerque, NM, USA

    Lee K. Brown

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Editors and Affiliations

  1. Orthodontics, Saint Louis University Orthodontics, Saint Louis, MO, USA

    Ki Beom Kim

  2. Orthodontics, Saint Louis University Orthodontics, Saint Louis, MO, USA

    Reza Movahed

  3. Washington University in St. Louis School of Medicine, Saint Louis, MO, USA

    Raman K. Malhotra

  4. Otolaryngology-Head and Neck Surgery, University of Michigan–Ann Arbor, Ann Arbor, MI, USA

    Jeffrey J. Stanley

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Ralls, F., Cutchen, L., Brown, L.K. (2021). Pathophysiology of Obstructive Sleep Apnea (OSA). In: Kim, K.B., Movahed, R., Malhotra, R.K., Stanley, J.J. (eds) Management of Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-030-54146-0_2

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