Surgery Therapy for Obstructive Sleep Apnea — Present and Future
The phenomenon of airway obstruction in sleep apnea syndrome is caused primarily by central nervous system failure to maintain integrity of pharyngeal airway during sleep. Specifically, normal activation of pharyngeal dilator muscles undergoes profound change from wakefulness to sleep. There is a loss of muscle tone within pharyngeal wall. The airway becomes narrower, necessitating greater inspiratory effort to maintain satisfactory airflow. This in turn exerts a further inward pressure within pharynx and consequently flaccid muscular walls of the pharynx collapse, causing the occlusion. A pharyngeal airway that anatomically has lumen narrower than normal is more likely to yield to the occlusive forces. Conversely airway defense by neuromuscular mechanism (compensating for unfavorable anatomy of the region) may in time lose its efficiency. Thus evolved hypertrophy and possible degenerative changes in the muscles of tongue, palate and pharyngeal walls may precipitate a point where neuromuscular function fails to maintain the airway under certain adverse conditions, e.g., sleep, anesthesia, etc. Historically, theory of a mechanism for pharyngeal airway occlusion in obstructive sleep apnea was embroiled in the controversy between the proponents of so-called active mechanism suggested by Weitzman et al. (1978) and passive mechanism proposed by Remmers et al. (1978) and others.
KeywordsObstructive Sleep Apnea Sleep Apnea Obstructive Sleep Apnea Syndrome Obstructive Sleep Apnea Patient Pharyngeal Airway
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