Upper airway factors that protect against obstructive sleep apnoea in healthy older males.
The prevalence of obstructive sleep apnoea (OSA) increases with age, yet the risk factors for OSA in older people remain poorly understood. This study aimed to define the age-related changes in upper airway morphology in carefully matched groups of healthy older (>60 years, n=11) and younger (<40 years, n=14) males, using direct (magnetic resonance imaging (MRI)) and indirect (acoustic reflection) imaging. The median (interquartile range) combined retropalatal and retroglossal pharyngeal length was greater in older than in younger males (older 8.8 (7.8-9.0) cm, younger 7.8 (7.0-8.3) cm; p=0.03), as was the soft palate cross-sectional area (older 43.1 (36.0-48.8) cm(2), younger 35.3 (30.5-40.5) cm(2); p=0.03), parapharyngeal fat pad diameter (older 1.7 (1.4-2.2) cm, younger 1.2 (1.0-1.8) cm; p=0.03) and cross-sectional area of the fat pads (older 13.8 (9.1-17.1) cm(2); younger 7.4 (5.9-13.0) cm(2); p=0.02) as measured by MRI. Using acoustic reflection, pharyngeal calibre (older 4.8 (3.8-6.6) cm(2), younger 3.4 (2.8-4.6) cm(2); p=0.03), pharyngeal volume (older 35.1 (30.9-55.4) cm(3), younger 27.2 (22.7-44.2) cm(3); p=0.04) and glottis area (older 2.7 (2.1-3.9) cm(2), younger 1.3 (1.1-1.9) cm(2); p=0.003) were also larger in older participants compared with younger participants. There was no difference in craniofacial measures between groups, including volumetric data and hyoid bone position. The larger pharyngeal calibre observed in older males may be compensating for an age-related enlargement in pharyngeal soft tissue that predisposes to OSA.
Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust, London, UK Both authors contributed equally.
Thomas
T
Carlisle
Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust, London, UK Both authors contributed equally.
Elliott R
ER
Carthy
Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust, London, UK.
Martin
M
Glasser
NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust, London, UK.
Peter
P
Drivas
Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust, London, UK.
Alison
A
McMillan
NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust, London, UK.
Martin R
MR
Cowie
Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust, London, UK.
Anita K
AK
Simonds
Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust, London, UK m.morrell@imperial.ac.uk.
Mary J
MJ
Morrell
D000162:Acoustics; D000328:Adult; D000367:Age Factors; D000368:Aged; D001696:Biomechanical Phenomena; D015992:Body Mass Index; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010160:Palate, Soft / Q000503:physiopathology; D010614:Pharynx / Q000473:pathology; D012137:Respiratory System; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000517:prevention & control; D055815:Young Adult