Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland.
Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
J Sleep Res. 2022 Aug;31(4):e13616. doi: 10.1111/jsr.13616. Epub 2022 May 24.
Obstructive sleep apnea (OSA) is characterised 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. OSA is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary, and neuropsychiatric, and there is growing evidence of bidirectional relationships between OSA and comorbidity, especially for heart failure, metabolic syndrome, and stroke. A detailed understanding of the complex pathophysiology of OSA encourages the development of therapies targeted at pathophysiological endotypes and facilitates a move towards precision medicine as a potential alternative to continuous positive airway pressure therapy in selected patients.
阻塞性睡眠呼吸暂停（OSA）的特征是睡眠期间上呼吸道反复阻塞，根本异常反映了上呼吸道扩张肌在吸气时无法抵抗上呼吸道内产生的负压。导致口咽狭窄的因素，如异常的颅面解剖结构、颈部软组织堆积和卧位时的颅向液体转移，增加了气道内的塌陷力。上呼吸道扩张肌的对抗力，特别是颏舌肌，受到睡眠开始、颏舌肌反应不足、通气不稳定（特别是觉醒后）和环路增益的负面影响。OSA 常与合并症相关，包括代谢、心血管、肾脏、肺部和神经精神疾病，并且越来越多的证据表明 OSA 和合并症之间存在双向关系，特别是心力衰竭、代谢综合征和中风。对 OSA 复杂病理生理学的详细了解鼓励针对病理生理表型开发治疗方法，并促进精准医学作为选择患者持续气道正压治疗的潜在替代方法。
