폐쇄성 수면 무호흡의 발병 기전
Mechanisms of obstructive sleep apnea development
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Although obstructive sleep apnea (OSA) is a major public health problem, the pathogenesis of OSA is not fully understood. According to recent studies, development of OSA generally depends on the followings : (1) upper airway anatomy, (2) the ability of upper airway dilator muscle to respond to stimulation, (3) loop gain, (4) arousal threshold. These factors determine upper airway patency and ventilatory control stability. Thus, abnormalities in these systems lead to a narrowed, more collapsible pharyngeal airway and ventilator control instability, which lead in turn to development of OSA. OSA is a heterogeneous disorder which can develop as the result of a variety of physiologic characteristics, and may differently respond to therapeutic approaches based on the predominant abnormality. Therefore, the treatment of OSA must be individualized to the cause of the development of OSA.
Abstract
Although obstructive sleep apnea (OSA) is a major public health problem, the pathogenesis of OSA is not fully understood. According to recent studies, development of OSA generally depends on the followings : (1) upper airway anatomy, (2) the ability of upper airway dilator muscle to respond to stimulation, (3) loop gain, (4) arousal threshold. These factors determine upper airway patency and ventilatory control stability. Thus, abnormalities in these systems lead to a narrowed, more collapsible pharyngeal airway and ventilator control instability, which lead in turn to development of OSA. OSA is a heterogeneous disorder which can develop as the result of a variety of physiologic characteristics, and may differently respond to therapeutic approaches based on the predominant abnormality. Therefore, the treatment of OSA must be individualized to the cause of the development of OSA.
참고문헌 (27)
- Horner RL, "Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea", Q J Med, 72, pp.719~735 (1989)
- Suto Y, "Evaluation of the pharyngeal airway in patients in sleep apnea:Value of untrafast MR imaging", Am J Roentgenol, 160, pp.311~314 (1993)
- Schwab RJ, "Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing: significance of the lateral pharyngeal walls", Am J Respir Crit Care Med, 152, pp.1673~1689 (1995)
- Haponik E, "Computerized tomography in obstructive sleep apnea: correlation of airway size with physiology during sleep and wakefulness", Am Rev Respir Dis, 127, pp.221~226 (1983)
- Schwab R, "Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep disordered breating", Am Rev Respir Dis, 148, pp.1375~1400 (1993)
- Remmers JE, "Pathogenesis of upper airway occlusion during sleep", J Appl Physiol, 44, pp.931~938 (1978)
- Cistulli PA, "Sleep and Breathing. Lung Biology in Health and Disease", pp.405~448 (1994), Marcel Dekker
- Isono S, "Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects", J Appl Physiol, 82, pp.1319~1326 (1997)
- Shelton KE, "Mandible enclosure of upper airway and weight in obstructive sleep apnea", Am Rev Respir Dis, 148, pp.195~200 (1993)
- Watanabe T, "Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing", Am J Respir Crit Care Med, 165, pp.260~265 (2002)
- Arens R, "Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome", Am J Respir Crit Care Med, 164, pp.698~703 (2001)
- Mathew OP, "Regulation of Breathing", pp.1064~1134 (1994), Marcel Dekker
- Mathew OP, "Influence of upper airway pressure changes on genioglossus and muscle respiratory activity", J Appl Physiol, 52, pp.438~ (1982)
- Mathew OP, "Genioglossus muscle response to upper airway pressure changes: afferent pathways", J Appl Physiol, 52, pp.445~ (1982)
- Horner RL, "Afferent pathway(s)for pharyngeal dilator reflex to negative pressure in man: a study using upper airway anaesthesia", J Physiol, 436, pp.31~44 (1991)
- Van Lunteren E, "Muscles of the pharynx: structural and contractile properties", Ear Nose Throat J, 72, pp.27~29 (1993)
- Horner RL, "Impact of brainstem sleep mechanism on pharyngeal motor control", Respir Physiol, 119, pp.113~121 (2000)
- Malhorta A, "Local mechanisms drive genioglossus muscle activation in obstructive sleep apnea", Am J Respir Crit Care Med, 161, pp.1746~1749 (2000)
- Mezzanotte WS, "Influence of sleep onset on upper airway muscle activity in apnea patients versus normal controls", Am J Respir Crit Care Med, 153, pp.1880~1887 (1996)
- Boyd J, "Upper airway muscle inflammation and denervation changes in obstructive sleep apnea", Am J Respir Crit Care Med, 170, pp.541~546 (2004)
- White DP, "Pathogenesis of obstructive and central sleep apnea", Am J Respir Crit Care Med, 172, pp.1363~1370 (2005)
- Khoo MCK, "Ventilatory dynamics during transient arousal from NREM sleep:implications for respiratory control stability", J Appl Physiol, 80(5), pp.1475~1484 (1996)
- Younes M, "Chemical control stability in patients with obstructive sleep apnea", Am J Respir Crit Care Med, 163, pp.1181~1190 (2001)
- Gleeson K, "The influence of increasing ventilatory effort on arousal from sleep", Am Rev Respir Dis, 142, pp.295~300 (1990)
- Gleeson K, "Chemosesitivity and the ventilator response to airflow obstruction during sleep", J Appl Physiol, 67, pp.1630~1637 (1989)
- Dempsey J, "Crossing the apnoeic threshold: causes and consequences", Exp Physiol, 90, pp.13~24 (2004)
- Kuna ST, "Pathophysiology of upper airway closure during sleep", JAMA, 266, pp.1384~1389 (1991)