School of Medicine, University College Dublin, Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland.
Adv Exp Med Biol. 2022;1384:31-42. doi: 10.1007/978-3-031-06413-5_3.
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.
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，其根本异常反映了上气道扩张肌在吸气时无法抵抗上气道内产生的负向力。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向前液体转移，增加了气道内的塌陷力。上气道扩张肌的对抗力，特别是颏舌肌，受到睡眠开始、颏舌肌反应不足、通气不稳定（尤其是觉醒后）和环路增益的负面影响。最近的报告表明，个体患者中存在反映 OSA 病理生理学的多种表型。对 OSA 复杂病理生理学的详细了解鼓励针对这些病理生理表型开发治疗方法，并促进将精准医学作为一种潜在替代持续气道正压通气治疗的选择，应用于特定患者。
