title: The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy.
abstract: 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.
authors.affiliation: Pneumology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Bosi
authors.affiliation: Head & Neck Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, 47121, Forlì, Italy. dr.andrea.devito@gmail.com.
authors.forename: Andrea
authors.identifier: http://orcid.org/0000-0002-9802-7716
authors.initials: A
authors.lastname: De Vito
authors.affiliation: Head and Neck Department, ENT Unit, Sant'Orsola University Hospital, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gobbi
authors.affiliation: Pneumology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Venerino
authors.initials: V
authors.lastname: Poletti
authors.affiliation: Head & Neck Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, 47121, Forlì, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Vicini
mesh_terms: D019468:Disease Management; D006801:Humans; D010347:Patient Care Planning; D010614:Pharynx / Q000473:pathology / Q000503:physiopathology; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000473:pathology / Q000503:physiopathology / Q000628:therapy
keywords: Arousal threshold; Critical passive pressure; Loop gain; Obstructive sleep apnoea hypopnea syndrome; Pathophysiology