Pathophysiological mechanisms in obstructive sleep apnea

Abstract

Over the last few years a clear picture has emerged of how upper airway occlusion is initiated in the obstructive sleep apnea syndrome. The evidence supports the idea that the airway walls and tongue become atonic in sleep and are sucked closed by negative intra-airway pressure during inspiratory efforts. However, less is known about the mechanisms which terminate the apneic period. Although the first descriptions of this syndrome by Gastaut et al. (1966) and Jung and Kuhlo (1965) reported evidence of arousal coinciding with the first loud gasping breath after the apnea and implied that arousal was an important part of the relief from obstruction, more recent studies have focused attention on the frequent occurrence of slow waves at the end of apnea (Krieger and Kurtz, 1978). The purpose of this report is to examine the role played by arousal mechanisms on obstructive apnea.