Obstructive sleep apnea: Current perspectives
Open accessAbstract
The prevalence of obstructive sleep apnea (OSA) continues to rise. So too do the health, safety, and economic consequences. On an individual level, the causes and consequences of OSA can vary substantially between patients. In recent years, four key contributors to OSA pathogenesis or "phenotypes" have been characterized. These include a narrow, crowded, or collapsible upper airway "anatomical compromise" and "non-anatomical" contributors such as ineffective pharyngeal dilator muscle function during sleep, a low threshold for arousal to airway narrowing during sleep, and unstable control of breathing (high loop gain). Each of these phenotypes is a target for therapy. This review summarizes the latest knowledge on the different contributors to OSA with a focus on measurement techniques including emerging clinical tools designed to facilitate translation of new cause-driven targeted approaches to treat OSA. The potential for some of the specific pathophysiological causes of OSA to drive some of the key symptoms and consequences of OSA is also highlighted.
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Insomnia disorder may be associated with a reduced respiratory arousal threshold, which may predispose patients to prematurely awaken to respiratory events.
“Alternatively, insomnia disorder may be associated with a reduced respiratory arousal threshold, which may predispose patients to prematurely awaken to respiratory events [16,105].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [16]
The Introduction’s “Respiratory arousal threshold” section says that some patients with OSA arouse to relatively small pressure changes and that premature arousal can interfere with stabilizing breathing. The “Prediction tools” section notes that insomnia commonly co-occurs with OSA, but does not say that insomnia disorder is associated with a reduced respiratory arousal threshold. Page numbers were not provided in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOSA is thought to result from a combination of anatomical and non-anatomical factors.
“OSA is thought to result from a combination of anatomical (e.g., a narrow pharyngeal airway), and non-anatomical factors (e.g., impaired upper airway muscle function, low arousal threshold, and unstable control of breathing) [16].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [16]
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Association between laryngopharyngeal reflux and obstructive sleep apnea in adults
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Osman, A. M., Toson, B., Naik, G. R., Mukherjee, S., Delbeck, M., Hahn, M. G., Müller, T. H., Weimann, G., & Eckert, D. J. (2024) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00541.2023 · Cited by 17 · see citing works
Self-citationDepressive Symptoms in Comorbid Obstructive Sleep Apnea and Insomnia: An Integrative Review
Jeon, B., Luyster, F. S., Callan, J. A., & Chasens, E. R. (2021) · Western Journal of Nursing Research · doi:10.1177/0193945921989656 · Cited by 17 · see citing works
Osman, A. M., Tong, B., Landry, S. A., Edwards, B. A., Joosten, S. A., Hamilton, G. S., Cori, J. M., Jordan, A. S., Stevens, D. J., Grunstein, R. R., et al. (2020) · SLEEP · doi:10.1093/sleep/zsaa067 · Cited by 18 · see citing works
Self-citationSun, J., Jia, X., Zhang, Z., Yang, Y., Zhai, C., Zhao, B., & Liu, Y. (2024) · Respiratory Research · doi:10.1186/s12931-024-02969-x · Cited by 16 · see citing works
Wadee, Z. A., Ooi, S. L., & Pak, S. C. (2022) · Biomedicines · doi:10.3390/biomedicines10092273 · Cited by 16 · see citing works
Ning, R., Chen, J., Lu, Y., & Guo, J. (2023) · BMC Oral Health · doi:10.1186/s12903-023-03264-9 · Cited by 16 · see citing works
- Authors
- Osman, A. M., Carter, S. G., Carberry, J. C., & Eckert, D. J.
- Affiliations
- UNSW Sydney (AU)
- Corresponding author
- Eckert, Danny J
- Venue
- Nature and Science of Sleep
- Publisher
- Informa UK Limited
- Published
- 2018-01
- Volume
- Volume 10
- Pages
- 21-34
- ISSN
- 1179-1608 (ISSN-L)
- PMC
- PMC5789079
- OpenAlex
- W2784442221
- Cited by
- 441
- References
- 186
- Citations by year
- 2026: 37 · 2025: 56 · 2024: 49 · 2023: 56 · 2022: 64 · 2021: 76 · 2020: 49 · 2019: 44 · 2018: 9
- FWCI
- 5.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nature and Science of Sleep (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- 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, OSA phenotypes, upper airway anatomy, arousal threshold, loop gain, targeted therapy
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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