Current insights in the pathophysiology of sleep disordered breathing

Sleep-related breathing disturbances include obstructive and central sleep apnea as well as sleep-related hypoventilation syndromes. The underlying pathophysiological characteristics of these diseases essentially differ. While obstructive sleep apnea is primarily due to upper airway collapse, central sleep apnea is mainly driven by a disturbed ventilatory control. Increased respiratory mechanical load and/or an impaired neuronal signal transduction/muscle dystrophy promote the occurrence of a (sleep-related) hypoventilation. Usually we diagnose one of these entities based on polysomnographic und capnometric characteristics, but frequently a co-existence of different pathophysiological aspects can be found. This is especially true in the multi-morbid elderly patient. In order to define disease entities more clearly and develop sufficient therapy concepts, a differentiated appraisal of each and every underlying disturbance is needed. Only the integrative therapy approach oriented towards the underlying pathophysiology facilitates effective suppression of sleep-related breathing disturbances and ensures long-term therapy adherence. This article describes current pathophysiological concepts of sleep-related breathing disturbances and is intended to help develop integrative therapy strategies oriented towards pathophysiology.