Many physiologic factors contribute to obstructive sleep apnea (OSA), including pharyngeal anatomy, dilator muscle activation, lung volumes, arousal threshold, and ventilatory control.1 Although it may be possible to examine the relative importance of these factors in research settings, there are no clinically available tests that can be used to treat patients accordingly (for example, using a sedative hypnotic agent for those patients with a low arousal threshold). Surgery is an anatomical treatment, and Woodson2 summarizes the evidence regarding identification of the pattern of obstruction and surgical treatment of OSA.
Kezirian EJ. Surgical Evaluation in Obstructive Sleep ApneaClimbing the Steep Part of the Learning Curve. JAMA Otolaryngol Head Neck Surg. 2014;140(6):568. doi:10.1001/jamaoto.2014.555