title: Upper airway function in the pathogenesis of obstructive sleep apnea: a review of the current literature.
abstract: OBJECTIVE
  Obstructive sleep apnea is an increasingly prevalent disease, with a considerable societal burden. The disease is defined by recurrent intermittent collapse of the upper airway. Understanding of and treatment for the disease is largely confined to relief of the mechanical obstruction of the upper airway by application of continuous positive airway pressure, and less commonly weight loss or surgery. However, recent work has focused on the function, rather than structure alone, of the upper airway.
  
  
  RESULTS
  The following contributors to upper airway structure and function have been studied: traditional fixed anatomical abnormalities, dynamic anatomical changes, upper airway dilator muscle dysfunction, lung volumes, and instability in control of breathing. In each patient with obstructive sleep apnea, the relative contribution of each of these components may be quite variable. The studies reviewed here describe methods to evaluate these factors, and some attempts at treatment.
  
  
  CONCLUSIONS
  Ongoing studies are attempting to classify patients on the basis of the underlying pathophysiology. This work suggests that obstructive sleep apnea is a heterogeneous disease with multiple root causes. Ultimately, such a classification may allow more individualized treatment, not only relying on mechanical relief of the upper airway obstruction.
authors.affiliation: Pulmonary & Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. rowens@partners.org
authors.forename: Robert L
authors.initials: RL
authors.lastname: Owens
authors.forename: Danny J
authors.initials: DJ
authors.lastname: Eckert
authors.forename: Susie Yim
authors.initials: SY
authors.lastname: Yeh
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
mesh_terms: D045422:Continuous Positive Airway Pressure; D006801:Humans; D010614:Pharynx / Q000503:physiopathology*; D011175:Positive-Pressure Respiration; D012132:Respiratory Muscles / Q000503:physiopathology; D012137:Respiratory System / Q000503:physiopathology*; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000503:physiopathology