Obstructive Sleep Apnea: Epidemiology, Pathophysiology, Complications, Diagnosis, Management, and Emerging Fibrosis-Linked Remodeling.
OSA is a complex systemic disease with potential fibrosis-linked remodeling effects, requiring more nuanced diagnostic metrics than currently used.
Where it sits
this study against the rest of the zenagamtide corpusSummary and findings
This review discusses the epidemiology, pathophysiology, complications, diagnosis, and management of obstructive sleep apnea (OSA), with a focus on fibrosis-linked remodeling. It emphasizes the limitations of conventional severity classifications and suggests physiologically enriched metrics for better risk assessment. The review also highlights the potential role of OSA in structural remodeling of various organs.
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent yet substantially underdiagnosed sleep-related breathing disorder increasingly recognized as a heterogeneous systemic disease rather than a purely mechanical consequence of recurrent upper-airway collapse. This review provides an updated and integrated overview of OSA, spanning epidemiology, multifactorial pathophysiology, heterogeneous clinical presentation, major cardiometabolic and end-organ consequences, diagnostic principles, and evolving personalized management, while also emphasizing the limitations of conventional severity classification, which is predominantly based on the apnea-hypopnea index. We highlight how intermittent hypoxia-reoxygenation, sleep fragmentation, sympathetic activation, intrathoracic pressure stress, endothelial dysfunction, inflammation, oxidative stress, and metabolic dysregulation interact to drive systemic injury, and why physiologically enriched metrics such as hypoxic burden, T90, event duration, sleep-stage dependency, and endotypic heterogeneity may better capture biological risk than event frequency alone. Within this broader framework, fibrosis-linked structural remodeling emerges as an important yet under-supported dimension of OSA pathobiology. Experimental and clinical evidence suggests that OSA may contribute to remodeling of the lungs, liver, kidneys, and heart, although the strength of the evidence and the degree of causal inference vary across organs. By integrating established knowledge with this emerging fibrosis-oriented perspective, this review defines key mechanistic, diagnostic, and translational priorities for future research and phenotype-aware clinical stratification.
Background
Obstructive sleep apnea (OSA) is increasingly recognized as a systemic disease with significant underdiagnosis. Traditional views consider it a mechanical issue due to upper-airway collapse, but emerging perspectives highlight its multifactorial pathophysiology. This review is significant as it integrates new insights into fibrosis-linked remodeling, potentially expanding the understanding of OSA's systemic impacts.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
This review synthesizes existing knowledge and emerging perspectives on OSA, particularly focusing on fibrosis-linked remodeling. While it provides a comprehensive overview, the lack of new experimental data limits its ability to establish causality. The review suggests that physiologically enriched metrics could improve risk assessment, but further research is needed to validate these approaches.
Key findings
- OSA is a highly prevalent and underdiagnosed disorder.
- Conventional severity classification is limited by reliance on the apnea-hypopnea index.
- Physiologically enriched metrics may better capture biological risk.
- OSA may contribute to fibrosis-linked remodeling of lungs, liver, kidneys, and heart.
- The strength of evidence for organ remodeling varies across organs.
Limitations
- Narrative review, no new data
- Causal inference varies across organs
- Limited by reliance on existing literature