Obstructive sleep apnea - pathogenesis and treatment

Obstructive sleep apnea is characterized by repetitive episodes of upper airway occlusion occurring during sleep. The clinical syndrome appears to occur in individuals who exhibit instability of ventilatory drive during light NREM sleep, and who also have subtle or overt abnormalities of their upper airway. The most prominent clinical manifestations are daytime hypersomnolence and loud snoring. Bypassing the area of obstruction with a tracheostomy results in an improvement in clinical symptoms, but cosmetic and medical problems associated with the procedure limit patient acceptance. Recently, protriptyline, nasal continuous positive airway pressure, and uvulopalatopharyngoplasty have been introduced as alternative treatment modalities in obstructive sleep apnea patients. Although the data are still preliminary, these less invasive modes of treatment are promising and might be considered in non life-threatening obstructive sleep apnea before resorting to tracheostomy.