Obstructive sleep apnea in older adults is a distinctly different physiological phenotype
- PMID: 25061251
- PMCID: PMC4098808
- DOI: 10.5665/sleep.3844
Obstructive sleep apnea in older adults is a distinctly different physiological phenotype
Abstract
Study objectives: Current evidence suggests that the pathological mechanisms underlying obstructive sleep apnea (OSA) are altered with age. However, previous studies examining individual physiological traits known to contribute to OSA pathogenesis have been assessed in isolation, primarily in healthy individuals.
Design: We assessed the four physiological traits responsible for OSA in a group of young and old patients with OSA.
Setting: Sleep research laboratory.
Participants: Ten young (20-40 y) and old (60 y and older) patients with OSA matched by body mass index and sex.
Measurements and results: Pharyngeal anatomy/collapsibility, loop gain (LG), upper airway muscle responsiveness/gain (UAG) and the respiratory arousal threshold were determined using multiple 2- to 3-min decreases or drops in continuous positive airway pressure (CPAP). Passive pharyngeal anatomy/collapsibility was quantified as the ventilation at CPAP = 0 cmH2O immediately after the CPAP drop. LG was defined as the ratio of the ventilatory overshoot to the preceding reduction in ventilation. UAG was taken as the ratio of the increase in ventilation to the increase in ventilatory drive across the pressure drop. Arousal threshold was estimated as the ventilatory drive that caused arousal. Veupnea was quantified as the mean ventilation prior to the pressure drop. In comparison with younger patients with OSA, older patients had a more collapsible airway (ventilation at 0 cmH2O = 3.4 ± 0.9 versus 1.5 ± 0.7 L/min; P = 0.05) but lower Veupnea (8.2 ± 0.5 versus 6.1 ± 0.4 L/min; P < 0.01) and a lower LG (5.0 ± 0.7 versus 2.9 ± 0.5; P < 0.05). The remaining traits were similar between groups.
Conclusions: Our data suggest that airway anatomy/collapsibility plays a relatively greater pathogenic role in older adults, whereas a sensitive ventilatory control system is a more prominent trait in younger adults with obstructive sleep apnea.
Citation: Edwards BA, Wellman A, Sands SA, Owens RL, Eckert DJ, White DP, Malhotra A. Obstructive sleep apnea in older adults is a distinctly different physiological phenotype.
Keywords: aging; loop gain; lung; obstructive sleep apnea; sleep disordered breathing; upper airway collapsibility.
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Comment in
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The Different Clinical Faces of Obstructive Sleep Apnea (OSA), OSA in Older Adults as a Distinctly Different Physiological Phenotype, and the Impact of OSA on Cardiovascular Events after Coronary Artery Bypass Surgery.Am J Respir Crit Care Med. 2015 Nov 1;192(9):1127-9. doi: 10.1164/rccm.201507-1472RR. Am J Respir Crit Care Med. 2015. PMID: 26360149 No abstract available.
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References
-
- Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5. - PubMed
-
- Roth T, Roehrs T, Rosenthal L. Hypersomnolence and neurocognitive performance in sleep apnea. Curr Opin Pulm Med. 1995;1:488–90. - PubMed
-
- Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84. - PubMed
-
- Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19–25. - PubMed
-
- Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162:893–900. - PubMed
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