Myosin heavy chain proteins are responsible for the development of obstructive sleep apnea syndrome

We introduce a hypothesis that obstructive sleep apnea syndrome (OSAS) is primarily caused by an inherited reduced adaptability of upper airway striated muscles such that they cannot maintain patency when there is reduced consciousness (sleep). This reduced ability is caused by a deficiency of the genes for specific myosin heavy chain (MHC) proteins, which are the primary source of muscle adaptability in adults and were initially described in the chewing muscles. The development of OSAS must be linked to problems with striated muscle because affected patients are capable of normal breathing when awake but their respiratory parameters deteriorate during sleep; OSAS must, therefore, be caused by a factor that is voluntarily active during waking but inactive during sleep, and this can only be striated muscle. Congenital or acquired anatomical abnormalities are involved only partially, because OSAS patients with anatomical abnormalities do not begin to snore or to have apneas or hypopneas when lying in bed awake, but begin to do so only when sleeping.