B H Shrikrishna, G Deepa, Sawal Anupama, Balwir Trupti P
Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND.
Anatomy, Datta Meghe Medical College, Nagpur, IND.
Cureus. 2023 Sep 1;15(9):e44525. doi: 10.7759/cureus.44525. eCollection 2023 Sep.
Repeated obstruction and closure of the upper airway, sporadic hypoxic episodes, and sympathetic activity are symptoms of obstructive sleep apnea (OSA). Obstructive sleep apnoea is due to a combination of altered upper airway structure and muscular function, a low arousal threshold and increased loop gain. Although recurrent upper airway (UA) collapse during sleep is the most frequent clinical hallmark of OSA, the exact cause of this collapse is unknown. Furthermore, while continuous positive airway pressure aids in the management of OSA, many patients find it intolerable. As a result, a better knowledge of the causes of OSA may result in more effective treatments. We did a review of randomized controlled trials that were done in this regard in the last 10 years and whose full-text version is available on the PubMed database. A total of 20 articles were finalized for review after applying our criteria. The articles have proposed different theories regarding the anatomical basis responsible for obstructive sleep apnoea. The theories proposed by different studies in the last decade include reduced genioglossus and hypoglossal nerve activity, the pharyngeal muscles' failure to keep the airway open or tighten it, tonsils and adenoid hypertrophy, an oversensitive ventilatory control system and low respiratory arousal threshold, mandibular position, pharyngeal muscles' high sympathetic drive, cephalometric alterations such as mandibular and hyoid bone position and the length of the soft palate, obesity, and neck fat and fluid re-distribution in the body, from the lower to the upper parts while reclining. Given the diverse etiological characteristics of OSA patients and to increase our knowledge of the condition, additional study into this group is required. Filling any knowledge gaps that may exist in the anatomical basis of the onset of OSA is the main objective of this review paper.
上气道反复阻塞与闭合、间歇性缺氧发作以及交感神经活动是阻塞性睡眠呼吸暂停（OSA）的症状。阻塞性睡眠呼吸暂停是由上气道结构改变和肌肉功能、低觉醒阈值以及环路增益增加共同导致的。虽然睡眠期间上气道反复塌陷是阻塞性睡眠呼吸暂停最常见的临床特征，但其确切原因尚不清楚。此外，尽管持续气道正压通气有助于阻塞性睡眠呼吸暂停的治疗，但许多患者难以耐受。因此，更好地了解阻塞性睡眠呼吸暂停的病因可能会带来更有效的治疗方法。我们对过去10年在这方面进行的随机对照试验进行了综述，这些试验的全文可在PubMed数据库中获取。在应用我们的标准后，共确定了20篇文章进行综述。这些文章提出了关于阻塞性睡眠呼吸暂停解剖学基础的不同理论。过去十年不同研究提出的理论包括颏舌肌和舌下神经活动减弱、咽部肌肉无法保持气道开放或收紧、扁桃体和腺样体肥大、通气控制系统过度敏感和呼吸觉醒阈值低、下颌位置、咽部肌肉的高交感神经驱动、头颅测量改变如下颌骨和舌骨位置以及软腭长度、肥胖以及身体在仰卧时颈部脂肪和液体从下部向上部的重新分布。鉴于阻塞性睡眠呼吸暂停患者病因特征多样，为增加我们对该疾病的了解，需要对这一群体进行更多研究。填补阻塞性睡眠呼吸暂停发病解剖学基础中可能存在的知识空白是本综述文章的主要目的。
