The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy

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• 作者：Marcello Bosi ; Andrea De Vito ; Riccardo Gobbi…
• 关键词：Obstructive sleep apnoea hypopnea syndrome ; Pathophysiology ; Loop gain ; Arousal threshold ; Critical passive pressure
• 刊名：European Archives of Oto-Rhino-Laryngology
• 出版年：2017
• 出版时间：March 2017
• 年：2017
• 卷：274
• 期：3
• 页码：1251-1261
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Otorhinolaryngology; Neurosurgery; Head and Neck Surgery;
• 出版者：Springer Berlin Heidelberg
• ISSN：1434-4726
• 卷排序：274

文摘

The objective of this study is to highlight the importance of anatomical and not-anatomical factors’ identification for customized therapy in OSAHS patients. The data sources are: MEDLINE, The Cochrane Library and EMBASE. A systematic review was performed to identify studies that analyze the role of multiple interacting factors involved in the OSAHS pathophysiology. 85 out of 1242 abstracts were selected for full-text review. A variable combinations pathophysiological factors contribute to realize differentiated OSAHS phenotypes: a small pharyngeal airway with a low resistance to collapse (increased critical closing pressure), an inadequate responses of pharyngeal dilator muscles (wakefulness drive to breathe), an unstable ventilator responsiveness to hypercapnia (high loop gain), and an increased propensity to wake related to upper airway obstruction (low arousal threshold). Identifying if the anatomical or not-anatomical factors are predominant in each OSAHS patient represents the current challenge in clinical practice, moreover for the treatment decision-making. In the future, if a reliable and accurate pathophysiological pattern for each OSAHS patient can be identified, a customized therapy will be feasible, with a significant improvement of surgical success in sleep surgery and a better understanding of surgical failure.