Chest
Volume 131, Issue 6, June 2007, Pages 1702-1709
Journal home page for Chest

ORIGINAL RESEARCH
SLEEP MEDICINE
The Influence of Aging on Pharyngeal Collapsibility During Sleep

https://doi.org/10.1378/chest.06-2653Get rights and content

Background

Aging increases vulnerability to obstructive sleep apnea (OSA), but the underlying mechanisms remain unclear. Recent data in awake healthy volunteers show a decrease in the genioglossus negative pressure reflex and anatomic compromise with increasing age, suggesting an age-related predisposition to pharyngeal collapse. However, aging effects on pharyngeal collapsibility have not been studied extensively during sleep. We tested the hypotheses that upper airway closing pressure (Pclose) and the increase in pharyngeal resistance during sleep (primary outcomes) as well as measures of arousal threshold (secondary outcomes) increase with age.

Methods

We studied 21 healthy individuals (8 women [mean (± SD) age, 36 ± 18 years] and 13 men [mean age, 41 ± 23 years]) who were between 18 and 75 years of age. During overnight polysomnography, we measured nasal pressure (Pmask) and epiglottic pressure (Pepi) during stage 2 sleep before and after airway occlusion (external valve) until arousal. Pclose was defined as the pressure at which Pmask plateaued despite further decreases in Pepi.

Results

Increasing age was correlated with both pharyngeal collapsibility ([Pclose] r = 0.69; p < 0.01) and an increase in pharyngeal resistance during sleep (r = 0.56; p < 0.01) independent of body mass index (BMI) and gender. There was no evidence for an effect of age on arousal threshold after airway occlusion during stage 2 sleep.

Conclusions

Older age is associated with increased pharyngeal airway collapsibility during sleep independent of gender and BMI. These data may at least partially explain the mechanisms underlying the predisposition for pharyngeal collapse in the elderly.

Section snippets

Subjects

With the approval of institutional review boards, we studied 21 consenting, healthy individuals who were between 18 and 75 years of age. The subjects were recruited using e-mail announcements and posters, and through the Harvard Cooperative on Aging. We studied 8 women (mean age, 36 years [SD, 18 years]; age range, 19 to 72 years) and 13 men (mean age, 41 years [SD, 23 years]; age range, 18 to 75 years). The women who were < 50 years old were premenopausal based on regular menstrual cycles,

Results

Two subjects (19 and 75 years old) were unable to sleep well such that the arousal threshold could not be assessed. In another subject (68 years old), pharyngeal resistance could not be measured because of consistent airflow limitation during early inspiration (flow rate, 0.2 L/s). All other subjects completed the entire study, and their mean (± SD) age, weight, height, and BMI were 39 ± 22 years (age range, 18 to 75 years), 66 ± 11 kg (weight range, 48 to 90 kg), 164 ± 8 cm (height range, 147

Discussion

Our study shows that age independently influences both upper airway collapsibility and the increase in pharyngeal resistance during sleep, whereas BMI and gender explained minimal variance of either end point. We did not find any evidence for aging effects on the threshold to arouse from sleep after airway occlusion. In older (nonsnoring) persons, the magnitude of both Pclose2526 and the increase in Rp during sleep26 were comparable to those in previous reports2526 from young persons who snored

References (40)

  • DR Dancey et al.

    Impact of menopause on the prevalence and severity of sleep apnea

    Chest

    (2001)
  • M Behan et al.

    Age-related changes in serotonin in the hypoglossal nucleus of rat: implications for sleep-disordered breathing

    Neurosci Lett

    (1999)
  • RJ Erskine et al.

    Effect of age on the sensitivity of upper airway reflexes

    Br J Anaesth

    (1993)
  • PE Peppard et al.

    Prospective study of the association between sleep-disordered breathing and hypertension

    N Engl J Med

    (2000)
  • FJ Nieto et al.

    Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study

    JAMA

    (2000)
  • JF Faccenda et al.

    Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome

    Am J Respir Crit Care Med

    (2001)
  • HK Yaggi et al.

    Obstructive sleep apnea as a risk factor for stroke and death

    N Engl J Med

    (2005)
  • JE Remmers et al.

    Pathogenesis of upper airway occlusion during sleep

    J Appl Physiol

    (1978)
  • RJ Schwab et al.

    Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging

    Am J Respir Crit Care Med

    (2003)
  • WS Mezzanotte et al.

    Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism)

    J Clin Invest

    (1992)
  • E Shahar et al.

    Hormone replacement therapy and sleep-disordered breathing

    Am J Respir Crit Care Med

    (2003)
  • HA Browne et al.

    Ageing does not influence the sleep-related decrease in the hypercapnic ventilatory response

    Eur Respir J

    (2003)
  • A Wellman et al.

    Chemical control of stability in the elderly

    J Physiol

    (2007)
  • IL Mortimore et al.

    Tongue protrusion strength and fatiguability: relationship to apnoea/hypopnoea index and age

    J Sleep Res

    (2000)
  • SE Martin et al.

    The effect of age, sex, obesity and posture on upper airway size

    Eur Respir J

    (1997)
  • R Thurnheer et al.

    Influence of age and gender on upper airway resistance in NREM and REM sleep

    J Appl Physiol

    (2001)
  • C Worsnop et al.

    Effect of age on sleep onset-related changes in respiratory pump and upper airway muscle function

    J Appl Physiol

    (2000)
  • T Shochat et al.

    Sleep disorders in the elderly

    Curr Treat Options Neurol

    (2001)
  • A Malhotra et al.

    Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse

    Am J Med

    (2006)
  • DP White et al.

    Pharyngeal resistance in normal humans: influence of gender, age, and obesity

    J Appl Physiol

    (1985)
  • Cited by (0)

    This work was supported by the National Institute of Aging (Beeson Award K23 AG024837–01), grants No. HL 60292 and RO1-HL73146.

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    View full text