International Journal of Head and Neck Surgery

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VOLUME 12 , ISSUE 2 ( April-June, 2021 ) > List of Articles

REVIEW ARTICLE

Pathophysiology of Obstructive Sleep Apnea: The Role of Physiologic Phenotypes

Alexandre R Abreu, Alberto R Ramos, Salim I Dib, Carlos Torre, Alejandro D Chediak

Citation Information : Abreu AR, Ramos AR, Dib SI, Torre C, Chediak AD. Pathophysiology of Obstructive Sleep Apnea: The Role of Physiologic Phenotypes. Int J Head Neck Surg 2021; 12 (2):71-73.

DOI: 10.5005/jp-journals-10001-1428

License: CC BY-NC 4.0

Published Online: 01-06-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Obstructive sleep apnea (OSA) is a common medical disorder of increasing interest in the medical community because of evidence that significant cardiovascular and neurocognitive defects occur when OSA is untreated or inadequately treated. Positive airway pressure (PAP) therapy remains the most effective and widely prescribed treatment for OSA. However, long-term adherence to PAP therapy has proven challenging. Alternative surgical and medical therapies are available, but an estimation of treatment efficacy based on clinical grounds has yielded inconsistent and largely disappointing results. The identification of a unique mechanism for OSA in a given clinical subject should prove useful in the selection of treatment alternatives to PAP. Until recently, personalizing treatment of OSA based on the determination of the mechanism of action was available only in experimental settings requiring invasive instrumentation. However, it is now possible to analyze clinical polysomnography data and identify the physiologic mechanism(s) or phenotype(s) of OSA in an individual case. The determination of physiologic phenotype offers the opportunity for personalized therapy. Additionally, physiologic phenotyping of OSA provides an opportunity to understand OSA mechanisms in specific subgroups, such as the elderly and the obese without OSA. In this manuscript, we introduce the reader to the concept and techniques of physiologic phenotyping of OSA and summarize the scientific data that physiologic phenotyping confers to understanding and treating OSA.


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  1. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177(9):1006–1014. DOI: 10.1093/aje/kws342.
  2. Kapur V, Blough DK, Sandblom RE, et al. The medical cost of undiagnosed sleep apnea. Sleep 1999;22(6):749–755. DOI: 10.1093/sleep/22.6.749.
  3. Lam JC, Mak JC, Ip MS. Obesity, obstructive sleep apnoea and metabolic syndrome. Respirology (Carlton, Vic) 2012;17(2):223–236. DOI: 10.1111/j.1440-1843.2011.02081.x.
  4. Berry R, Brooks R, Gamaldo C, et al. In: Medicine AAoS, ed., The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Darien, Illinois: American Academy of Sleep Medicine; 2017.
  5. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proceed Am Thora Soc 2008;5(2):173–178. DOI: 10.1513/pats.200708-119MG.
  6. Edwards BA, Wellman A, Sands SA, et al. Obstructive sleep apnea in older adults is a distinctly different physiological phenotype. Sleep 2014;37(7):1227–1236. DOI: 10.5665/sleep.3844.
  7. Younes M, Ostrowski M, Atkar R, et al. Mechanisms of breathing instability in patients with obstructive sleep apnea. J Appl Physiol 2007;103(6):1929–1941. DOI: 10.1152/japplphysiol.00561.2007.
  8. Sands SA, Eckert DJ, Jordan AS, et al. Enhanced upper-airway muscle responsiveness is a distinct feature of overweight/obese individuals without sleep apnea. Am J Respirat Criti Care Med 2014;190(8):930–937. DOI: 10.1164/rccm.201404-0783OC.
  9. Eckert DJ, White DP, Jordan AS, et al. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respirat Criti Care Med 2013;188(8):996–1004. DOI: 10.1164/rccm.201303-0448OC.
  10. Joosten SA, Leong P, Landry SA, et al. Loop gain predicts the response to upper airway surgery in patients with obstructive sleep apnea. Sleep 2017;40(7). DOI: 10.1093/sleep/zsx094.
  11. Edwards BA, Sands SA, Eckert DJ, et al. Acetazolamide improves loop gain but not the other physiological traits causing obstructive sleep apnoea. J Physiol 2012;590(5):1199–1211. DOI: 10.1113/jphysiol.2011.223925.
  12. Sands SA, Edwards BA, Terrill PI, et al. Phenotyping pharyngeal pathophysiology using polysomnography in patients with obstructive sleep apnea. Am J Respirat Criti Care Med 2018;197(9):1187–1197. DOI: 10.1164/rccm.201707-1435OC.
  13. Edwards BA, Eckert DJ, McSharry DG, et al. Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea. Am J Respirat Criti Care Med 2014;190(11):1293–1300. DOI: 10.1164/rccm.201404-0718OC.
  14. Terrill PI, Edwards BA, Nemati S, et al. Quantifying the ventilatory control contribution to sleep apnoea using polysomnography. The Eur Respirat J 2015;45(2):408–418. DOI: 10.1183/09031936.00062914.
  15. Eckert DJ, Owens RL, Kehlmann GB, et al. Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold. Clin Sci (Lond) 2011;120(12):505–514. DOI: 10.1042/CS20100588.
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