Figure 1.

There are four general pathways that contribute to the development of recurrent obstructive apneas during sleep ¹²; under the heading for each pathway there are listed current of potential (e.g. “drugs?”) treatments that might act in a management of the syndrome related to multiple obstructive apneas. These pathways are not mutually exclusive, and treatment of one may uncover the impact of others. For instance, CPAP therapy may not address a high loop gain or an intrinsic problem with arousal thresholds, and this can complicate treatment responses. HNS addresses the pathway with poor muscle activation, mitigating the fall in muscle activity that occurs at the onset of an apnea.