THE MULTIFACTORIAL ETIOLOGY OF OBSTRUCTIVE SLEEP APNEA
Abstract
Obstructive sleep apnea (OSA) is a condition that affects hundreds of millions of people worldwide. The direct and indirect costs associated with the treatment of OSA and its complications place a significant burden on healthcare systems. It is estimated that a large proportion of individuals remain undiagnosed, and the available treatment options often fail to produce satisfactory outcomes. In addition to the long-term, potentially serious complications, patients frequently struggle with daily symptoms that substantially reduce their quality of life. At present, it is crucial to raise awareness among specialists across various medical fields and involve them in the diagnostic process. All of this is intended to restore patients’ quality of life and protect them from long-term complications.
This paper is based on an analysis of research articles: original papers, review papers and clinical cases published on PubMed between 2020 and 2025. Its aim is to highlight the complex etiology of OSA and the resulting diagnostic and therapeutic opportunities, which should involve multidisciplinary collaboration. Such an approach allows for personalized treatment strategies, better aligned with individual variability, and offers the best possible therapeutic outcomes for each patient.
References
Malhotra A, Mesarwi O, Pepin JL, et al. 2020. Endotypes and phenotypes in obstructive sleep apnea. Curr Opin Pulm Med., 26(6):609-614. DOI: 10.1097/MCP.0000000000000724
Tsai MS, Chen HC, Liu SY, et al. 2022. Holistic care for obstructive sleep apnea (OSA) with an emphasis on restoring nasal breathing: A review and perspective. J Chin Med Assoc., 85(6):672-678. DOI: 10.1097/JCMA.0000000000000737
Martinez-Garcia MA. 2022. Multidimensional approach to obstructive sleep apnea, Pulmonology, 28(3):158-160. DOI: https://doi.org/10.1016/j.pulmoe.2022.01.006
Wang X, Zhang J, Zou J, et al. 2025. Polysomnographic endotypes of successful multilevel upper airway surgery for obstructive sleep apnea. Sleep. 48(5):zsaf012. DOI: 10.1093/sleep/zsaf012
SP Patil, IA Ayappa, SM Caples, et al. 2019. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 15(2):335-343. DOI: https://doi.org/10.5664/jcsm.7640
Ding Q, Kryger M. 2020. Greater health care utilization and cost associated with untreated sleep apnea. J Clin Sleep Med. 16(1):5–6. DOI: doi.org/10.5664/jcsm.8152
Cheng WJ, Finnsson E, Arnardóttir E, et al. 2023. Relationship between Symptom Profiles and Endotypes among Patients with Obstructive Sleep Apnea: A Latent Class Analysis. Ann Am Thorac Soc. 20(9):1337-1344. DOI: 10.1513/AnnalsATS.202212-1054OC
Sanchez-Azofra A, Malhotra A, Owens RL, et al. 2023. Obstructive Sleep Apnea: Pathophysiology and Endotypes. ATS Sch. 4(4):567-568. DOI: 10.34197/ats-scholar.2023-0022OT
Gambino F, Zammuto MM, Virzì A, et al. 2022. Treatment options in obstructive sleep apnea. Intern Emerg Med. 17(4):971-978. DOI: 10.1007/s11739-022-02983-1
Leung TN, Cheng JW, Chan AK. 2021. Paediatrics: how to manage obstructive sleep apnoea syndrome. Drugs Context. 10:2020-12-5. DOI: 10.7573/dic.2020-12-5
Alansari RA. 2022. The role of orthodontics in management of obstructive sleep apnea. Saudi Dent J. 34(3):194-201. DOI: 10.1016/j.sdentj.2022.02.001
Carrasco A, Sjölander I, Van Acker A, et al. 2021. The Tonsil Lymphocyte Landscape in Pediatric Tonsil Hyperplasia and Obstructive Sleep Apnea. Front Immunol. 12:674080. DOI: 10.3389/fimmu.2021.674080
Johnson C, Leavitt T, Daram SP, et al. 2022. Obstructive Sleep Apnea in Underweight Children. Otolaryngol Head Neck Surg. 167(3):566-572. DOI: https://doi.org/10.1177/01945998211058722
Wu Y, Zheng L, Cui G, et al. 2022. Subtypes of obstructive sleep apnea in children and related factors. J Clin Sleep Med. 18(10):2397-2404. DOI: 10.5664/jcsm.10124
Randall DA. 2020. Current Indications for Tonsillectomy and Adenoidectomy. J Am Board Fam Med. 33(6):1025-1030. DOI: 10.3122/jabfm.2020.06.200038
Matarredona-Quiles S, Carrasco-Llatas M, Apodaca PM, et al. 2022. Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea? Braz J Otorhinolaryngol. 88(Suppl5):156-161. DOI: 10.1016/j.bjorl.2021.12.002
Lackey TG, Tholen K, Pickett K, et al. 2023. Residual OSA in Down syndrome: does body position matter? J Clin Sleep Med. 19(1):171-177. DOI: 10.5664/jcsm.10288
Landry SA, Beatty C, Thomson LDJ, et al. 2023. A review of supine position related obstructive sleep apnea: Classification, epidemiology, pathogenesis and treatment. Sleep Medicine Rev. 72:101847. DOI: https://doi.org/10.1016/j.smrv.2023.101847
Wasef S, Mir S, Ryan C, et al. 2021. Treatment for patients with sleep apnea on opioids for chronic pain: results of the OpSafe trial. J Clin Sleep Med. 17(4):819-824. DOI: 10.5664/jcsm.9064
Chen K, Yaggi HK, Fiellin DA, et al. 2020. Associations between obstructive sleep apnea and prescribed opioids among veterans. Pain. 161(9):2035-2040. DOI: 10.1097/j.pain.0000000000001906
Cutrufello N, Ianus V, Rowley. 2020. Opioids and sleep. Curr Opin Pulm Med. 26(6):p 634-641. DOI: 10.1097/MCP.0000000000000733
Kendzerska T, Gomes T, Malhotra A, et al. 2022. Association of obstructive sleep apnea and opioids use on adverse health outcomes: A population study of health administrative data. PLoS One. 17(6):e0269112. DOI: 10.1371/journal.pone.0269112
Borrelli M, Corcione A, Rongo R, et al. 2022. Obstructive Sleep Apnoea in Children with Down Syndrome: A Multidisciplinary Approach. J Pers Med. 13(1):71. DOI: 10.3390/jpm13010071
Silva DBE, Corrêa CC, Weber SAT. 2024. Orofacial myofunctional and polysomnographic characteristics of children with Down syndrome and obstructive sleep apnea: a pilot study. Codas. 36(3):e20230119. DOI: 10.1590/2317-1782/20242023119en
Seither K, Helm BM, Heubi C, et al. 2023. Sleep Apnea in Children With Down Syndrome. Pediatrics. 151(3):e2022058771. DOI: 10.1542/peds.2022-058771
de las Fuentes Monreal M, Capote Moreno AL, Wix Ramos R, Muñoz-Guerra MF, et al. 2024. Skeletal surgical approach in Down Syndrome with Obstructive Sleep Apnea. J Craniomaxillofac Surg. 52(10):1155-1163. DOI: https://doi.org/10.1016/j.jcms.2024.08.001
Abijay CA, Tomkies A, Rayasam S, et al. 2022. Children With Down Syndrome and Obstructive Sleep Apnea: Outcomes After Tonsillectomy. Otolaryngol Head Neck Surg. 166(3):557-564. DOI: 10.1177/01945998211023102
Zhang J, Kohzuka Y, Bennett KM, et al. 2024. Case reports of oral appliance therapy on three young adults with Down syndrome and OSA. J Prosthodont. DOI: 10.1111/jopr.13997
Finch CE, Raol N, Roser SM, et al. 2024. Multisystem approach for management of OSA in Down syndrome: a case report. J Clin Sleep Med. 20(3):471-473. DOI: 10.5664/jcsm.10914
Copyright (c) 2025 Zuzanna Romanowska, Weronika Lusarczyk, Natalia Sapeda, Karolina Gorczyca, Adrianna Truszyńska-Zawisza, Aleksandra Młocek, Aleksandra Białas
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