The pathogenesis of obstructive sleep apnea

Luu V. Pham, Alan R. Schwartz

Research output: Contribution to journalReview articlepeer-review

42 Scopus citations


Obstructive sleep apnea (OSA) is a major source of cardiovascular morbidity and mortality, and represents an increasing burden on health care resources. Understanding underlying pathogenic mechanisms of OSA will ultimately allow for the development of rational therapeutic strategies. In this article, we review current concepts about the pathogenesis of OSA. Specifically, we consider the evidence that the upper airway plays a primary role in OSA pathogenesis and provide a framework for modelling its biomechanical properties and propensity to collapse during sleep. Anatomical and neuromuscular factors that modulate upper airway obstruction are also discussed. Finally, we consider models of periodic breathing, and elaborate generalizable mechanisms by which upper airway obstruction destabilizes respiratory patterns during sleep. In our model, upper airway obstruction triggers a mismatch between ventilatory supply and demand. In this model, trade-offs between maintaining sleep stability or ventilation can account for a full range of OSA disease severity and expression. Recurrent arousals and transient increases in airway patency may restore ventilation between periods of sleep, while alterations in neuromuscular and arousal responses to upper airway obstruction may improve sleep stability at still suboptimal levels of ventilation.

Original languageEnglish (US)
Pages (from-to)1358-1372
Number of pages15
JournalJournal of Thoracic Disease
Issue number8
StatePublished - Jan 1 2015


  • Inspiratory flow limitation
  • Obstructive sleep apnea (OSA)
  • Starling resistor
  • Upper airway

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


Dive into the research topics of 'The pathogenesis of obstructive sleep apnea'. Together they form a unique fingerprint.

Cite this