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THE INFLUENCE OF AGING ON PHARYNGEAL COLLAPSIBILITY DURING SLEEP

¹Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA ²Department of General Clinical Research Center and Biometrics, Beth Israel Medical Center, Boston, MA ³Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA ⁴Klinik für Anästhesiologie und Intensivmedizin, Universitaetsklinikum Essen, Germany ⁵Department of Thoracic Medicine, Chang Gang Memorial Hospital, Chang Gang University College of Medicine, Taipei, Taiwan

meikermann{at}rics.bwh.harvard.edu

Abstract

BACKGROUNDAging increases vulnerability to obstructive sleep apnea (OSA), but the underlying mechanisms remain unclear. Recent data in awake normal volunteers show a decrease in the genioglossus negative pressure reflex and anatomical 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 (P_CLOSE) and the increase in pharyngeal resistance during sleep (primary outcomes) as well as measures of arousal threshold (secondary outcomes) increase with age.

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

RESULTSIncreasing age was correlated with both pharyngeal collapsibility (P_CLOSE r=0.69, p<0.01) and an increase in pharyngeal resistance during sleep (r=0.56, p<0.01) independent of BMI and gender. There was no evidence for an effect of age on arousal threshold after airway occlusion during stage 2 sleep.

CONCLUSIONSOlder 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.