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Cited by 441Obstructive Sleep Apnea ResearchNeuroscience of respiration and sleepSleep and related disorders

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Obstructive sleep apnea: current perspectives

Open access
Osman, Amal M, Carter, Sophie G, Carberry, Jayne C, Eckert, Danny J·2018·Nature and Science of Sleep
DOI 10.2147/nss.s124657PMC PMC5789079
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Abstract

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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Figures

Figure 1 Schematic of the anatomical and non-anatomical causes of OSA. Notes: Some degree of anatomical vulnerability is present in OSA. However, the extent of impairment varies widely between patients. The non-anatomical contributors, which are present in approximately 70% of OSA patients, play a key role in mediating the absence or presence of OSA. In the schematic, the gray tracings indicate the desired response, whereas the black tracings represent impairment in the non-anatomical trait. Refer to the text for further detail. Reprinted from Chest, Carberry JC, Amatoury J, Eckert DJ, Personalized management approach for OSA, Epub 2017 June 16, Copyright (2017), with permission from Elsevier.36 Abbreviations: EEG, electroencephalography; EMG, genioglossus electromyography; MTA, 100 ms moving time average of the rectified raw EMG signal; OSA, obstructive sleep apnea.
Figure 1 Schematic of the anatomical and non-anatomical causes of OSA. Notes: Some degree of anatomical vulnerability is present in OSA. However, the extent of impairment varies widely between patients. The non-anatomical contributors, which are present in approximately 70% of OSA patients, play a key role in mediating the absence or presence of OSA. In the schematic, the gray tracings indicate the desired response, whereas the black tracings represent impairment in the non-anatomical trait. Refer to the text for further detail. Reprinted from Chest, Carberry JC, Amatoury J, Eckert DJ, Personalized management approach for OSA, Epub 2017 June 16, Copyright (2017), with permission from Elsevier.36 Abbreviations: EEG, electroencephalography; EMG, genioglossus electromyography; MTA, 100 ms moving time average of the rectified raw EMG signal; OSA, obstructive sleep apnea.CC BY-NC · PubMed Central
Figure 2 Example of minimal genioglossus muscle responsiveness. Notes: In this example of a naturally occurring apnea, despite clear phasic activation of the genioglossus muscle (as shown in the raw and MTA genioglossus EMG channels), there is minimal activation of genioglossus during the respiratory event. This is despite substantial increasing negative epiglottic pressure (Pepi) swings from the first to last effort (last effort nadir epiglottic pressure = arousal threshold). It is only when cortical arousal occurs (as shown in the EEG channel) that major genioglossus activation occurs (signal clipped in this example) and airflow is restored. Abbreviations: EEG, electroencephalography; EMG, genioglossus electromyography; MTA, 100 ms moving time average of the rectified raw EMG signal.
Figure 2 Example of minimal genioglossus muscle responsiveness. Notes: In this example of a naturally occurring apnea, despite clear phasic activation of the genioglossus muscle (as shown in the raw and MTA genioglossus EMG channels), there is minimal activation of genioglossus during the respiratory event. This is despite substantial increasing negative epiglottic pressure (Pepi) swings from the first to last effort (last effort nadir epiglottic pressure = arousal threshold). It is only when cortical arousal occurs (as shown in the EEG channel) that major genioglossus activation occurs (signal clipped in this example) and airflow is restored. Abbreviations: EEG, electroencephalography; EMG, genioglossus electromyography; MTA, 100 ms moving time average of the rectified raw EMG signal.CC BY-NC · PubMed Central
Figure 3 Example of robust genioglossus muscle responsiveness and restoration of airflow without cortical arousal. Notes: In contrast to the example in Figure 2, in this example of a naturally occurring hypopnea, there is robust activation of the genioglossus muscle (as shown in the raw and MTA genioglossus EMG channels), to increasing negative epiglottic pressure (Pepi) swings from the first to last effort which ultimately results in recovery of airflow without cortical arousal. Abbreviations: EEG, electroencephalogram; EMG, genioglossus electromyography; MTA, 100 ms moving time average of the rectified raw EMG signal.
Figure 3 Example of robust genioglossus muscle responsiveness and restoration of airflow without cortical arousal. Notes: In contrast to the example in Figure 2, in this example of a naturally occurring hypopnea, there is robust activation of the genioglossus muscle (as shown in the raw and MTA genioglossus EMG channels), to increasing negative epiglottic pressure (Pepi) swings from the first to last effort which ultimately results in recovery of airflow without cortical arousal. Abbreviations: EEG, electroencephalogram; EMG, genioglossus electromyography; MTA, 100 ms moving time average of the rectified raw EMG signal.CC BY-NC · PubMed Central
Figure 4 Example of robust genioglossus muscle responsiveness without restoration of airflow. Notes: In contrast to the example in Figure 3, in this example of a naturally occurring apnea, there is robust activation of the genioglossus muscle (as shown in the raw and MTA genioglossus EMG channels) to increasing negative epiglottic pressure (Pepi) swings from the first to last effort (last effort nadir epiglottic pressure = arousal threshold). However, despite substantial genioglossus muscle activation during the apnea, it is insufficient to restore airflow, which only occurs with cortical arousal (as shown in the EEG channel). The genioglossus signal is clipped in this example when airflow is restored with arousal. Abbreviations: EEG, electroencephalogram; EMG, genioglossus electromyography; MTA, 100 ms moving time average of the rectified raw EMG signal.
Figure 4 Example of robust genioglossus muscle responsiveness without restoration of airflow. Notes: In contrast to the example in Figure 3, in this example of a naturally occurring apnea, there is robust activation of the genioglossus muscle (as shown in the raw and MTA genioglossus EMG channels) to increasing negative epiglottic pressure (Pepi) swings from the first to last effort (last effort nadir epiglottic pressure = arousal threshold). However, despite substantial genioglossus muscle activation during the apnea, it is insufficient to restore airflow, which only occurs with cortical arousal (as shown in the EEG channel). The genioglossus signal is clipped in this example when airflow is restored with arousal. Abbreviations: EEG, electroencephalogram; EMG, genioglossus electromyography; MTA, 100 ms moving time average of the rectified raw EMG signal.CC BY-NC · PubMed Central

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Metadata

Authors
Osman, A. M., Carter, S. G., Carberry, J. C., & Eckert, D. J.
Affiliations
UNSW Sydney (AU)
Corresponding author
Eckert, Danny J
ORCID
Venue
Nature and Science of Sleep
Publisher
Informa UK Limited
Published
2018-01
Volume
Volume 10
Pages
21-34
ISSN
1179-1608 (ISSN-L)
DOI
10.2147/nss.s124657
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
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 (medical) › 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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