Abstract
Purpose of Review
The purpose of this review is to examine the pathogenesis of obstructive sleep apnea with emphasis on the respiratory arousal threshold, as its estimation and modification through medical interventions is a purported target to treat obstructive sleep apnea.
Recent Findings
Low respiratory arousal threshold endotype OSA can be readily identified by routine PSG, and is common among Caucasians, Australians, patients with BMI < 30 kg/m
2
, increasing age, those taking antidepressants, and up to 55% of patients with posttraumatic stress disorder. This trait may be predictive of low adherence to positive airway pressure therapy. Intervention aiming to increase low respiratory arousal threshold intervention may enhance positive airway pressure treatment adherence. Furthermore, in obstructive sleep apnea mediated primarily or solely by low respiratory arousal threshold, its manipulation with pharmaceuticals offers opportunity for precision intervention.
Summary
A significant number of obstructive sleep apnea patients have abnormally low respiratory arousal threshold as a primary pathogenic driver of upper airway instability during sleep. Increasing the respiratory arousal threshold may reduce apnea–hypopnea index in such patients. Furthermore, lowering of abnormally elevated respiratory arousal threshold in obstructive sleep apnea patients can reduce apnea–hypopnea index. Therefore, perturbation of the respiratory arousal threshold might serve as primary therapy in some and adjuvant therapy in others with obstructive sleep apnea. However, further studies are necessary to determine if pharmaceutically targeting the respiratory arousal threshold in obstructive sleep apnea improves symptoms and health outcomes.
