Mechanisms and Management of Obstructive Sleep Apnea: A Translational Overview

Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of upper airway obstruction during sleep, resulting in apnea and hypopnea. While anatomical factors, such as increased upper airway collapsibility, significantly contribute to OSA, emerging evidence highlights the importance of non-anatomical mechanisms, including impaired pharyngeal muscle responsiveness, low arousal threshold, and elevated ventilatory loop gain. The interplay of these factors leads to respiratory instability, fragmented sleep, and systemic complications. Additional pathophysiological influences such as obesity, aging, sex differences, and central nervous system dysfunction exacerbate cardiovascular and metabolic comorbidities. Advancements in diagnostic methods, including cephalometry and polysomnography, along with therapies such as continuous positive airway pressure, mandibular advancement devices, and hypoglossal nerve stimulation, underscore the necessity for personalized treatment approaches. Although surgical interventions targeting multi-level airway obstructions show potential for successful treatment, they remain limited by variability in long-term efficacy. A thorough understanding of the multifactorial mechanisms underlying OSA is crucial for improving diagnostic accuracy and tailoring patient-specific management strategies. This review summarizes recent findings, clarifying the complex pathophysiology of OSA and high-lighting a multidimensional approach to optimize patient outcomes.