Skip to main content
SpringerLink
Log in

Obstructive sleep apnea — pathogenesis and treatment

  • Review
  • Published:
Lung Aims and scope Submit manuscript

Abstract

Obstructive sleep apnea is characterized by repetitive episodes of upper airway occlusion occurring during sleep. The clinical syndrome appears to occur in individuals who exhibit instability of ventilatory drive during light NREM sleep, and who also have subtle or overt abnormalities of their upper airway. The most prominent clinical manifestations are daytime hypersomnolence and loud snoring. Bypassing the area of obstruction with a tracheostomy results in an improvement in clinical symptoms, but cosmetic and medical problems associated with the procedure limit patient acceptance. Recently, protriptyline, nasal continuous positive airway pressure, and uvulopalatopharyngoplasty have been introduced as alternative treatment modalities in obstructive sleep apnea patients. Although the data are still preliminary, these less invasive modes of treatment are promising and might be considered in non life-threatening obstructive sleep apnea before resorting to tracheostomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aserinsky E (1965) Periodic respiratory pattern occurring in conjunction with eye movements during sleep. Science 150:763–766

    Article  PubMed  CAS  Google Scholar 

  2. Afzelius LE, Elmqvist D, Hougaard K, Laurin S, Nilsson B, Risberg AM (1981) Sleep apnea syndrome — an alternative treatment to tracheostomy. Laryngoscope 91:285–291

    Article  PubMed  CAS  Google Scholar 

  3. Anch AM, Remmers JE, Bunce H III (1982) Supraglottic airway resistance in normal subjects and patients with occlusive sleep apnea. J Appl Physiol 53:1158–1163

    Article  PubMed  CAS  Google Scholar 

  4. Bear SE, Priest JH (1980) Sleep apnea syndrome: correction with surgical advancement of the mandible. J Oral Surg 38:543–549

    PubMed  CAS  Google Scholar 

  5. Block AJ, Boysen PG, Wynne JW, Hunt LA (1979) Sleep apnea, hypopnea and oxygen desaturation in normal subjects: a strong male predominance. N Engl J Med 300:513–517

    Article  PubMed  CAS  Google Scholar 

  6. Brownell LG, West P, Sweatman P, Acres JC, Kryger MH (1982) Protriptyline in obstructive sleep apnea — a double-blind trial. N Engl J Med 307:1037–1042

    Article  PubMed  CAS  Google Scholar 

  7. Bulow K (1963) Respiration and wakefulness in man. Acta Physiol Scand 59:1–110

    Google Scholar 

  8. Cartwright RD, Samelson CF (1982) The effects of a nonsurgical treatment for obstructive sleep apnea — the tongue-retaining device. JAMA 248:705–709

    Article  PubMed  CAS  Google Scholar 

  9. Cherniack NS (1981) Respiratory dysrhythmias during sleep. N Engl J Med 305:325–330

    PubMed  CAS  Google Scholar 

  10. Clark RW, Schmidt HS, Schaal SF, Boudoulas H, Schuller DE (1979) Sleep apnea: treatment with protriptyline. Neurology 29:1287–1292

    PubMed  CAS  Google Scholar 

  11. Conway WA, Victor LD, Magilligan DJ, Fujita S, Zorick FJ, Roth T (1981) Adverse effects of tracheostomy for sleep apnea. JAMA 246:347–350

    Article  PubMed  CAS  Google Scholar 

  12. Conway WA, Zorick F, Piccione P, Roth T (1982) Protriptyline in the treatment of sleep apnea. Thorax 37:49–53

    PubMed  CAS  Google Scholar 

  13. Cummiskey J, Lynne-Davies P, Guilleminault C (1978) Sleep study and respiratory function in myotonic dystrophy. In: Guilleminault C, Dement WC (eds) Sleep apnea syndromes. Liss, New York, pp 273–274 (Kroc Foundation Series, vol 11)

    Google Scholar 

  14. DeOlazabal JR, Miller MJ, Cook WR, Mithokfer JC (1982) Disordered breathing and hypoxia during sleep in coronary artery disease. Chest 82:548–552

    CAS  Google Scholar 

  15. Dolly FR, Block AJ (1982) Effect of flurazepam on sleep-disordered breathing and noctural oxygen desaturation in asymptomatic subjects. Am J Med 73:239–243

    Article  PubMed  CAS  Google Scholar 

  16. Fujita S, Conway W, Zorick F, Roth T (1981) Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 89:923–934

    PubMed  CAS  Google Scholar 

  17. Gastaut H, Tassinari CA, Duron B (1966) Polygraphic study of the episodic and nocturnal (hypoxic and respiratory) manifestations of the Pickwick syndrome. Brain Res 2:167–186

    Article  Google Scholar 

  18. Grassino A, Goldman MD, Mead J, Sears TA (1978) Mechanics of the human diaphragm during voluntary contraction: statistics. J Appl Physiol 44:829–839

    PubMed  CAS  Google Scholar 

  19. Guilleminault C, Cummiskey J (1982) Progressive improvement of apnea index and ventilatory response to CO2 after tracheostomy in obstructive sleep apnea syndrome. Am Rev Respir Dis 126:14–20

    PubMed  CAS  Google Scholar 

  20. Guilleminault C, Cummiskey J, Dement WC (1980) Sleep apnea syndrome: recent advances. Adv Intern Med 26:347–372

    PubMed  CAS  Google Scholar 

  21. Guilleminault C, Hill MW, Simmons FB, Dement WC (1978) Obstructive sleep apnea: electromyographic and fiberoptic studies. Exp Neurol 62:48–67

    Article  PubMed  CAS  Google Scholar 

  22. Guilleminault C, Simmons FB, Motta J, et al (1981) Obstructive sleep apnea syndrome and tracheostomy — long-term follow-up experience. Arch Intern Med 141:985–988

    Article  PubMed  CAS  Google Scholar 

  23. Haponik EF, Bleecker ER, Allen RP, Smith PL, Kaplan J (1981) Abnormal inspiratory flow volume curves in patients with sleep disordered breathing. Am Rev Respir Dis 124:571–574

    PubMed  CAS  Google Scholar 

  24. Haponik EF, Smith PL, Bohlman ME, Allen RP, Goldman SM, Bleecker ER (1983) CT scanning in obstructive sleep apnea: correlation of structure with airway physiology during sleep and wakefulness. Am Rev Respir Dis 127:221–226

    PubMed  CAS  Google Scholar 

  25. Harman EM, Wynne JW, Block AJ (1982) The effect of weight loss on sleep-disordered breathing and oxygen desaturation in morbidly obese men. Chest 82:291–294

    PubMed  CAS  Google Scholar 

  26. Heimer D, Scharf SM, Lieberman A, Lavie P (1983) Sleep apnea syndrome treated by repair of deviated nasal septum. Chest 84:184–185

    PubMed  CAS  Google Scholar 

  27. Hernandez SF (1982) Palatopharyngoplasty for the obstructive sleep apnea syndrome: technique and preliminary report of results in ten patients. Am J Otolaryngol 3:229–234

    PubMed  CAS  Google Scholar 

  28. Hill R, Robbins AW, Messing R, Arora NS (1983) Sleep apnea syndrome after poliomyelitis. Am Rev Respir Dis 127:129–131

    PubMed  CAS  Google Scholar 

  29. Imes NK, Orr WC, Smith AO, Rogers RM (1975) Retrognathia and sleep apnea. JAMA 237:1517–1596

    Google Scholar 

  30. Issa FG, Sullivan CE (1982) Alcohol, snoring and sleep apnea. J Neurol Neurosurg Psychiatry 45:353–359

    Article  PubMed  CAS  Google Scholar 

  31. Krieger AJ (1978) Sleep apnea produced by cervical cordotomy and other neurosurgical lesions in man. In: Guilleminault C, Dement WC (eds) Sleep apnea syndromes. Liss, New York, pp 273–274 (Kroc Foundation Series, vol 11)

    Google Scholar 

  32. Krieger J, Mangin P, Kurtz D (1982) Almitrine and sleep apnea. Lancet II:210

    Article  Google Scholar 

  33. Kuhlo W, Doll E, Frank MD (1969) Erfolgreiche Behandlung eines Pickwick-Syndroms durch eine Davertracheal Kanüle. Dtsch Med Wochenschr 94:1286–1290

    Article  PubMed  CAS  Google Scholar 

  34. Kuo PC, West RA, Bloomquist DS, McNeil RW (1979) The effect of mandibular osteotomy in three patients with hypersomnia sleep apnea. J Oral Surg 48:385–392

    Article  CAS  Google Scholar 

  35. Lavie P, Fischel N, Zomer J, Eliaschar I (1983) The effects of partial and complete occlusion of the nasal passages on sleep structure and breathing in sleep. Acta Otolaryngol (Stockh) 95:161–166

    CAS  Google Scholar 

  36. Lehrman KL, Guilleminault C, Schroeder JS, Tilkian A, Forno LS (1978) Sleep apnea in a patient with Shy-Drager syndrome. Arch Intern Med 138:206–209

    Article  PubMed  CAS  Google Scholar 

  37. Longobardo GS, Gothe B, Goldman MD, Cherniack NS (1982) Sleep apnea considered as control system instability. Respir Physiol 50:311–333

    Article  PubMed  CAS  Google Scholar 

  38. Lugaresi E, Coccagna A, Mantovani M (1978) Hypersominia with periodic apnea. In: Weitzman ED (ed) Advances in sleep research, vol 4. Spectrum, New York, p 115

    Google Scholar 

  39. Mahadevia AK, Onal E, Lopata M (1982) Expiratory positive airway pressure reduces sleep induced respiratory abnormalities in patients with hypersomnia-sleep apnea syndrome. Clin Res 30:750A

    Google Scholar 

  40. Mangat D, Orr WC, Smith RO (1977) Sleep apnea, hypersomnolence, and upper airway obstruction secondary to adeno-tonsillar enlargement. Arch Otolaryngol 103:383–386

    PubMed  CAS  Google Scholar 

  41. Martin RJ, Sanders MH, Gray BA, Pennock BE (1982) Acute and long-term ventilatory effects of hyperoxia in the adult sleep apnea syndrome. Am Rev Respir Dis 125:175–180

    PubMed  CAS  Google Scholar 

  42. Mathew OP, Abu-Osba YK, Thach BT (1982) Influence of upper airway pressure changes on genioglossus muscle respiratory activity. J Appl Physiol 52:438–444

    PubMed  CAS  Google Scholar 

  43. Mauer KW, Staats BA, Olsen KD (1983) Upper airway obstruction and disordered nocturnal breathing in children. Mayo Clin Proc 58:349–353

    PubMed  CAS  Google Scholar 

  44. McNicholas WT, Tarlo S, Cole P, et al (1982) Obstructive apneas during sleep in patients with seasonal allergic rhinitis. Am Rev Respir Dis 126:625–628

    PubMed  CAS  Google Scholar 

  45. Mendelson WB, Garnett D, Gillin JC (1981) Flurazepam-induced sleep apnea syndrome in a patient with insomnia and mild sleep-related respiratory changes. J Nerv Ment Dis 169:261–264

    Article  PubMed  CAS  Google Scholar 

  46. Mezon BJ, West P, Maclean JP, Kryger MH (1980) Sleep apnea in acromegaly. Am J Med 69:615–618

    Article  PubMed  CAS  Google Scholar 

  47. Motta J, Guilleminault C (1978) Effects of oxygen administration in sleep-induced apneas. In: Guilleminault C, Dement WC (eds) Sleep apnea syndromes. Liss, New York, pp 137–144 (Kroc Foundation Series, vol 11)

    Google Scholar 

  48. Motta J, Guilleminault C, Schroeder JS, Dement WC (1978) Tracheostomy and hemodynamic changes in sleep-induced apnea. Ann Intern Med 89:454–458

    PubMed  CAS  Google Scholar 

  49. Muller NL, Francis PW, Gurwitz D, Levison H, Bryan AC (1980) Mechanism of hemoglobin desaturation during rapid-eye-movement sleep in normal subjects and in patients with cystic fibrosis. Am Rev Respir Dis 121:463–469

    PubMed  CAS  Google Scholar 

  50. Olsen KD, Suh KW, Staats BA (1981) Surgically correctible causes of sleep apnea syndrome. Otolaryngol Head Neck Surg 89:726–731

    PubMed  CAS  Google Scholar 

  51. Onal E, Lopata M (1982) Periodic breathing and the pathogenesis of occlusive sleep apneas. Am Rev Respir Dis 126:676–680

    PubMed  CAS  Google Scholar 

  52. Onal E, Lopata M, O’Connor T (1982) Pathogenesis of apneas in hypersomnia-sleep apnea syndrome. Am Rev Respir Dis 125:167–174

    PubMed  CAS  Google Scholar 

  53. Orr WC, Imes NK, Martin RJ (1979) Progesterone therapy in obese patients with sleep apnea. Arch Intern Med 139:109–111

    Article  PubMed  CAS  Google Scholar 

  54. Phillipson EA (1979) Breathing disorders during sleep. Basics RD 7:1–6

    Google Scholar 

  55. Phillipson EA (1978) Control of breathing during sleep. Am Rev Respir Dis 118:909–938

    PubMed  CAS  Google Scholar 

  56. Rapoport DM, Sorkin B, Garay SM, Goldring RM (1982) Reversal of the “Pickwickian Syndrome” by long-term use of nocturnal nasal-airway pressure. N Engl J Med 307:931–933

    Article  PubMed  CAS  Google Scholar 

  57. Remmers JE, DeGroot WJ, Sauerland EK, Anch AM (1978) Neural and mechanical factors controlling pharyngeal occlusion during sleep. In: Guilleminault C, Dement WC (eds) Sleep apnea syndromes. Liss, New York, pp 211–217 (Kroc Foundation Series, vol 11)

    Google Scholar 

  58. Remmers JE, DeGroot WJ, Sauerland EK, Anch AM (1978) Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 44:931–938

    PubMed  CAS  Google Scholar 

  59. Sandblom RE, Matsumoto AM, Schoene RB, Lee KA, Giblin EL, Bremner WJ, Pierson DJ (1983) Obstructive sleep apnea syndrome: induced by testosterone administration. N Engl J Med 308:508–510

    Article  PubMed  CAS  Google Scholar 

  60. Sanders MH, Moore SE (1983) Inspiratory and expiratory partitioning of airway resistance during sleep in patients with sleep apnea. Am Rev Respir Dis 127:554–555

    PubMed  CAS  Google Scholar 

  61. Sanders MH, Moore SE, Eveslage J (1983) CPAP via nasal mask; a treatment for occlusive apnea. Chest 83:144–145

    PubMed  CAS  Google Scholar 

  62. Sauerland EK, Harper RM (1976) The human tongue during sleep: electromyograph activity of the genioglossus muscle. Exp Neurol 51:160

    Article  PubMed  CAS  Google Scholar 

  63. Sauerland EK, Mitchell SP (1975) Electromyographic activity of intrinsic and extrinsic muscles of the human tongue. Tex Rep Biol Med 33:445–455

    Google Scholar 

  64. Sciema L, Broudy M, Nay KN, Cohn MA (1982) Increased severity of obstructive sleep apnea after bedtime alcohol ingestion: diagnostic potential and proposed mechanism of action. Sleep 5:318–328

    Google Scholar 

  65. Simmons FB (1979) Tracheotomy in obstructive sleep apnea patients. Laryngoscope 89:1702–1703

    Article  PubMed  CAS  Google Scholar 

  66. Skatrud J, Iber C, Ewart R, Thomas G, Rasmussen H, Schultze B (1981) Disordered breathing during sleep in hypothyroidism. Am Rev Respir Dis 124:325–329

    PubMed  CAS  Google Scholar 

  67. Smith PL, Gehris C, Haponik EF, Allen RP, Bohlman M, Bleecker E (1983) Uvulopharyngoplasty in sleep apnea. Am Rev Respir Dis 127:85

    Google Scholar 

  68. Smith PL, Haponik EF, Allen RP, Bleecker E (1983) Oxygen therapy in sleep apnea. Am Rev Respir Dis 127:107

    Google Scholar 

  69. Smith PL, Haponik EF, Allen RP, Bleecker ER (1983) The effects of protriptyline in sleep-disordered breathing. Am Rev Respir Dis 127:8–13

    PubMed  CAS  Google Scholar 

  70. Strohl KP, Hensley MJ, Saunders NA, Scharf SM, Brown R, Ingram RH (1981) Progesterone administration and progressive sleep apnea. JAMA 245:1230–1232

    Article  PubMed  CAS  Google Scholar 

  71. Strohl KP, Saunders NA, Geldman NT, Hallett M (1978) Obstructive sleep apnea in family members. N Engl J Med 299:969–973

    Article  PubMed  CAS  Google Scholar 

  72. Sullivan CE, Berthon-Jones M, Issa FG (1983) Remission of severe obesity-hypoventilation syndrome after short-term treatment during sleep with nasal continuous positive airway pressure. Am Rev Respir Dis 128:177–181

    PubMed  CAS  Google Scholar 

  73. Sullivan CE, Issa FA (1981) Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet I:862–865

    Article  Google Scholar 

  74. Suratt PM, Dee P, Atkinson RL, Armstrong P, Wilhoit SC (1983) Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis 127:487–492

    PubMed  CAS  Google Scholar 

  75. Taasan VC, Block AJ, Boysen PG, Wynne J (1981) Alcohol increases sleep apnea and oxygen desaturation in asymptomatic men. Am J Med 71:240–245

    Article  PubMed  CAS  Google Scholar 

  76. Tilkian A, Guilleminault C, Schroeder J, Lehrman K, Simmons F, Dement W (1976) Hemodynamics in sleep-induced apnea; studies during wakefulness and sleep. Ann Intern Med 85:714–719

    PubMed  CAS  Google Scholar 

  77. Vallgo A, Atroy A (1965) Hypoventilation in acquired micrognathia. Arch Intern Med 115:307–310

    Google Scholar 

  78. Walsh RE, Michaelson ED, Harkleroad LE, Ziselboim A, Sackner MA (1972) Upper airway obstruction in obese patients with sleep disturbance and somnolence. Ann Intern Med 76:185–192

    PubMed  CAS  Google Scholar 

  79. Webb P (1974) Periodic breathing during sleep. J Appl Physiol 37:899–903

    PubMed  CAS  Google Scholar 

  80. Webb P, Hiestand W (1975) Sleep metabolism and age. J Appl Physiol 38:257–262

    PubMed  CAS  Google Scholar 

  81. Weitzman ED, Kahn E, Pollak CP (1980) Quantitative analysis of sleep and sleep apnea before and after tracheostomy in patients with the hypersomnia-sleep apnea syndrome. Sleep 3:407–423

    PubMed  CAS  Google Scholar 

  82. Weitzman ED, Pollak C, Boroweicki B, Burack B, Shprintzn R, Rukoff S (1977) The hypersomnia sleep apnea syndrome: site and mechanism of upper airway obstruction. Sleep Res 6:182

    Google Scholar 

  83. Wilms D, Conway W, Popovich J, Fujita S, Zorick F, Roth T (1982) Anatomic abnormalities in upper airway sleep apnea. Chest 82:236

    Google Scholar 

  84. Wynne JW (1982) Obstruction of the nose and breathing during sleep. Chest 82:657–658

    PubMed  CAS  Google Scholar 

  85. Zwillich CW, Pickett C, Hanson FN, Weil JV (1981) Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis 124:158–160

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Respiratory Sciences, and the Sleep Disorders Laboratory, The University of Arizona College of Medicine, 85724, Tucson, Arizona, USA

    Mark H. Gotfried & Stuart F. Quan

Authors
  1. Mark H. Gotfried
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stuart F. Quan
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gotfried, M.H., Quan, S.F. Obstructive sleep apnea — pathogenesis and treatment. Lung 162, 1–13 (1984). https://doi.org/10.1007/BF02715623

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02715623

Key words

Search

Navigation