Impact of sleep-disordered breathing treatment on upper airway anatomy and physiology

• Treatment reverses inflammatory, autonomic, and anatomic changes of OSA.
• CPAP improves edema, increases airway volume, inflammation, and sympathetic activity.
• Mandibular advancement devices increase pharyngeal area and decrease oxidative stress.
• Upper airway surgical intervention improves pharyngeal area volume and reduces Pcrit.
• Weight loss decreases nasopharyngeal collapsibility and increases pharyngeal area.

Sleep-disordered breathing (SDB) is a major public health problem. Various anatomic, pathophysiologic, and environmental changes contribute to SDB. The successful treatment of SDB reverses many of these abnormal processes. The present article discusses the current clinical evidence that supports the reversibility and its potential application in the management of SDB. Continuous positive airway pressure reduces angiogenesis and inflammatory edema, increases pharyngeal size, and improves surrogate markers of vascular inflammation and tongue muscle fiber types. Mandibular advancement devices lead to favorable maxillary and mandibular changes, increase pharyngeal area, and improve hypertension. Uvulopalatopharyngoplasty increases posterior airway space and pharyngeal volume, reduces nasal and oral resistance, and lowers response to high CO2. Weight loss reduces nasopharyngeal collapsibility, critical closing pressure of the airway, apnea–hypopnea index, and improves oxygen saturations. Potential clinical benefits of these changes in the management of SDB and patient compliance with treatment are discussed.