Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA.
Int J Oral Maxillofac Surg. 2010 Dec;39(12):1149-59. doi: 10.1016/j.ijom.2010.09.007. Epub 2010 Oct 27.
Obstructive sleep apnea (OSA) is a disorder characterized by repetitive, episodic collapse of the pharyngeal airway. Over the last two decades, understanding of the pathophysiology of sleep disordered breathing, which includes OSA, has improved. Once thought to be predominately related to anatomic constriction of the maxillomandibular complex, central nervous system regulation of breathing is now recognized as a significant contributor to the pathogenesis of OSA. Ventilator control, the central response to chemoreceptor phenomena, has important implications for oral and maxillofacial surgeons who treat OSA, particularly for patients who appear refractory to treatment with maxillomandibular advancement (MMA). The purpose of this article is to review the biomechanics of the upper airway as it relates to the pathophysiology of OSA, to discuss emerging concepts of ventilator control mechanisms in normal sleep versus sleep-disordered breathing and to discuss the concept of complex sleep apnea, a new category of sleep disordered breathing with both obstructive and central features.
阻塞性睡眠呼吸暂停（OSA）是一种以咽气道反复、间歇性塌陷为特征的疾病。在过去的二十年中，人们对包括 OSA 在内的睡眠呼吸障碍的病理生理学的理解已经得到了提高。人们曾经认为它主要与上下颌复合体的解剖狭窄有关，而现在呼吸的中枢神经系统调节被认为是 OSA 发病机制的一个重要因素。通气控制，即对化学感受器现象的中枢反应，对治疗 OSA 的口腔颌面外科医生具有重要意义，特别是对那些似乎对上下颌前突（MMA）治疗无反应的患者。本文的目的是回顾上气道的生物力学与 OSA 的病理生理学的关系，讨论正常睡眠和睡眠障碍呼吸时通气控制机制的新观点，并讨论复杂睡眠呼吸暂停的概念，这是一种具有阻塞性和中枢性特征的新型睡眠障碍呼吸类别。
