Underlying Mechanisms of Obstructive Sleep Apnea: A Review.

Abstract

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurrent upper airway obstruction during sleep, leading to apnea and hypopnea. While anatomical factors such as upper airway collapsibility are significant contributors, emerging evidence underscores the role of non-anatomical mechanisms, including impaired pharyngeal muscle responsiveness, low arousal threshold, and high ventilatory loop gain. Interplay of these factors can cause respiratory instability, sleep fragmentation, and systemic complications. The pathophysiology of OSA is further influenced by obesity, aging, gender differences, and central nervous system dysfunction, contributing to cardiovascular and metabolic comorbidities. Advances in diagnostic techniques such as cephalometry and polysomnography, along with therapies including continuous positive airway pressure, mandibular advancement devices, and hypoglossal nerve stimulation highlight the need for personalized treatment approaches. Although surgical interventions targeting multi-level airway obstructions also show promise, they are limited by variable long-term efficacy. A comprehensive understanding of OSA's multifactorial mechanisms is crucial for improving diagnostic accuracy and tailoring management strategies. This review summarizes recent findings to elucidate the complex pathophysiology of OSA and emphasizes a multidimensional approach to optimize patient outcomes.