Pathogenesis of sleep apnea

Ludovico Messineo, Danny J. Eckert

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

3 Citations (Scopus)


Sleep apnea is a common and heterogeneous disorder. Depending on the prevailing level of respiratory effort, three different forms of sleep apnea can manifest: obstructive, central, or mixed. The pathogenesis of sleep apnea is characterized by alteration of one or more of the following physiological traits: (1) anatomical impairment-a collapsible upper airway, which is the key determinant of obstructive apneas, (2) respiratory control or loop gain, which if abnormally high (very sensitive to small changes in CO2), can cause central apneas and contribute to cyclical breathing in obstructive sleep apnea but if too low, can cause sleep hypoventilation, (3) the propensity to arouse from sleep (arousal threshold), and (4) upper airway dilator muscle function during sleep. Because patients with obesity hypoventilation syndrome are obese and frequently have severe sleep apnea, this chapter reviews the latest knowledge on sleep apnea pathogenesis, including highlighting key pathophysiological differences between nonobese versus and obese patients with sleep apnea. Links between sleep apnea phenotypes and severe obstructive sleep apnea (OSA) are also briefly highlighted.

Original languageEnglish
Title of host publicationObesity Hypoventilation Syndrome
Subtitle of host publicationFrom Physiologic Principles to Clinical Practice
EditorsAiman Tulaimat
Place of PublicationLondon, United Kingdom
Number of pages12
ISBN (Print)9780128152904
Publication statusPublished - 2020


  • Arousal threshold
  • Critical closing pressure
  • Leptin
  • Loop gain
  • Obesity
  • Phenotyping
  • Upper airway muscle responsiveness

Cite this