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Cited by 545Obstructive Sleep Apnea ResearchNeuroscience of respiration and sleepSleep and related disorders

Phenotypic approaches to obstructive sleep apnoea – New pathways for targeted therapy

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Eckert, Danny J.·2018·Sleep Medicine Reviews
DOI 10.1016/j.smrv.2016.12.003
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Abstract

People develop obstructive sleep apnoea (OSA) for different reasons. The ability to understand these reasons, easily identify them in individual patients, and develop therapies that target one or more of these reasons are the keys to unlocking new approaches for the treatment of OSA. In line with this approach, recent advances in OSA pathogenesis using upper airway and respiratory phenotyping techniques have identified four key causes of OSA. A narrow or collapsible upper airway ('impaired anatomy') is the primary cause. However, the anatomical contribution to OSA varies substantially. Indeed, impairment in pharyngeal anatomy can be modest and in many patients (∼20%), pharyngeal collapsibility asleep is not different to people without OSA. Thus, non-anatomical factors or 'phenotypes' that modulate pharyngeal patency are crucial determinants of OSA for many people. These include impairment in pharyngeal dilator muscle control and function during sleep, increased propensity for awakening during airway narrowing (low respiratory arousal threshold) and respiratory control instability (high loop gain). Each phenotype is a potential therapeutic target. This review summarises the recent advances in the understanding of OSA pathogenesis according to a phenotypic approach, emerging tools to identify the phenotypes, and potential new therapeutic pathways and interventions to treat this common disorder.

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  • Evidence is accumulating that physiologically targeted treatment for OSA may effectively decrease the AHI and thus lower the pathophysiological burden of the disorder.

    “Evidence is accumulating that physiologically targeted treatment for OSA may effectively decrease the AHI and thus lower the pathophysiological burden of the disorder (Eckert, 2018).”

    From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Eckert, 2018

  • OSA is a male-preponderant disease that is more prevalent with advanced age, particularly in the presence of obesity.

    “It is a male-preponderant disease that is more prevalent with advanced age, particularly in the presence of obesity [12, 102].”

    From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [102]

  • Some people with OSA have severe anatomical compromise (Pcrit > +2 cmH2O), others have intermediate or moderate anatomical impairment (Pcrit between -2 and +2 cmH2O), while some have only minor anatomical impairment (Pcrit < -2 cmH2O).

    “some people with OSA have severe anatomical compromise (Pcrit > + 2 cmH2O), others have intermediate or moderate anatomical impairment (Pcrit between -2 to + 2 cmH2O), while some have only minor anatomical impairment (Pcrit < -2cmH2O).”

    From Multilevel-Single Stage–Functional Rhinoplasty &amp; BRP (Barb Reposition Palatoplasty) in Surgical Management of Primary Snorers, UARS and Mild OSA (2024) · cites this paper as [9]

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Authors
Eckert, D. J.
Affiliations
UNSW Sydney (AU)
Corresponding author
Eckert, Danny J.
ORCID
Eckert, Danny J.
Venue
Sleep Medicine Reviews
Publisher
Elsevier BV
Published
2018-02
Volume
37
Pages
45-59
ISSN
1087-0792 (ISSN-L)
DOI
10.1016/j.smrv.2016.12.003
OpenAlex
W2565665126
Cited by
545
References
115
Citations by year
2026: 72 · 2025: 62 · 2024: 56 · 2023: 71 · 2022: 72 · 2021: 77 · 2020: 49 · 2019: 43 · 2018: 25 · 2017: 17 · 2012: 1
FWCI
3.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Sleep Medicine Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
Funders
National Health and Medical Research Council (1049814, 1060992)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
obstructive sleep apnea, OSA pathogenesis, upper airway anatomy, pharyngeal collapsibility, loop gain, targeted therapy, upper airway imaging
MeSH terms
Arousal, Humans, Pharynx, Phenotype, Sleep, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure, Precision Medicine

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