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Obstructive Sleep Apnoea: Focus on Pathophysiology

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Advances in the Diagnosis and Treatment of Sleep Apnea

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1384))

Abstract

Obstructive sleep apnoea (OSA) is characterized by recurring episodes of upper airway obstruction during sleep and the fundamental abnormality reflects the inability of the upper airway dilating muscles to withstand the negative forces generated within the upper airway during inspiration. Factors that result in narrowing of the oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation in the neck, and rostral fluid shift in the recumbent position increase the collapsing forces within the airway. The counteracting forces of upper airway dilating muscles, especially the genioglossus, are negatively influenced by sleep onset, inadequacy of the genioglossus responsiveness, ventilatory instability, especially post arousal, and loop gain. Recent reports indicate that multiple endotypes reflecting OSA pathophysiology are present in individual patients. A detailed understanding of the complex pathophysiology of OSA encourages the development of therapies targeted at these pathophysiological endotypes and facilitates a move towards precision medicine as a potential alternative to continuous positive airway pressure therapy in selected patients.

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  1. School of Medicine, University College Dublin, Department of Respiratory and Sleep Medicine, St. Vincent’s Hospital Group, Dublin, Ireland

    Walter T. McNicholas

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Correspondence to Walter T. McNicholas .

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  1. Sleep Medicine Center, Charite Universitätsmedizin Berlin, Berlin, Berlin, Germany

    Thomas Penzel

  2. Biomedical Engineering Group, University of Valladolid, Valladolid, Spain

    Roberto Hornero

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McNicholas, W.T. (2022). Obstructive Sleep Apnoea: Focus on Pathophysiology. In: Penzel, T., Hornero, R. (eds) Advances in the Diagnosis and Treatment of Sleep Apnea . Advances in Experimental Medicine and Biology, vol 1384. Springer, Cham. https://doi.org/10.1007/978-3-031-06413-5_3

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