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Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea

Journal

Publisher

CHURCHILL LIVINGSTONE
DOI: 10.1016/j.ijom.2010.09.007

Keywords

obstructive sleep apnea; airway dynamics; maxillomandibular advancement; orthognathic surgery

Funding

  1. Oral and Maxillofacial Surgery Foundation
  2. AO/Synthes Research Fellowship in Pediatric Maxillofacial Surgery
  3. Massachusetts General Hospital Department of Oral and Maxillofacial Surgery Center for Applied Clinical Investigation and Education and Research Fund
  4. National Heart, Lung and Blood Institute, National Institutes of Health [1RC1HL099749-01]

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Obstructive sleep apnea (OSA) is a disorder characterized by repetitive, episodic collapse of the pharyngeal airway. Over the last two decades, understanding of the pathophysiology of sleep disordered breathing, which includes OSA, has improved. Once thought to be predominately related to anatomic constriction of the maxillomandibular complex, central nervous system regulation of breathing is now recognized as a significant contributor to the pathogenesis of OSA. Ventilator control, the central response to chemoreceptor phenomena, has important implications for oral and maxillofacial surgeons who treat OSA, particularly for patients who appear refractory to treatment with maxillomandibular advancement (MMA). The purpose of this article is to review the biomechanics of the upper airway as it relates to the pathophysiology of OSA, to discuss emerging concepts of ventilator control mechanisms in normal sleep versus sleep-disordered breathing and to discuss the concept of complex sleep apnea, a new category of sleep disordered breathing with both obstructive and central features.

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