Upper airway factors that protect against obstructive sleep apnoea in healthy older males

Carlisle, Thomas; Carthy, Elliott; Glasser, Martin; Drivas, Peter; McMillan, Alison; Cowie, Martin R.; Simonds, Anita K.; Morrell, Mary J.

doi:10.1183/09031936.00177213

Cited by 30 publications

(29 citation statements)

References 29 publications

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“…Age, sex and obesity all play a role, as do upper airway anatomy/physiology [5] and control of breathing [6,7], but these traditional risk factors are all measured at an individual level rather than at a household, community or city level. Many conditions, particularly in respiratory medicine, are driven by environmental factors that may exist at a household level (tobacco smoke exposure or solid fuel heating), community level (for instance, urban noise levels [8]) or municipal/city level ( pollen counts and heatwaves).…”

mentioning

confidence: 99%

Completely scoobied: the confusing world of temperature and pollution effects on sleep apnoea

Marshall

Cowie

2015

Eur Respir J

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@ERSpublications Four key studies clearly contradictory over the effects of temperature on sleep apnoea and it is not clear why http://ow.ly/RWg41Aficionados of 1970s and 1980s cartoons will have no trouble imagining the look of befuddlement upon our faces reminiscent of Scooby Doo's when presented with a new mystery. Normally in an editorial, one should write a nice, succinct summary of the field providing the reader with a clear but concise understanding of where we are and where we are heading. However, it is just not possible in this case. The evidence is truly befuddling. The four key studies [1][2][3][4] are not just inconsistent with respect to the effects of temperature on sleep apnoea, they are clearly contradictory and it is not clear why. So, this will be an editorial that poses more questions than it answers.The risk factors for sleep apnoea are already well described at both clinical and population levels. Age, sex and obesity all play a role, as do upper airway anatomy/physiology [5] and control of breathing [6,7], but these traditional risk factors are all measured at an individual level rather than at a household, community or city level. Many conditions, particularly in respiratory medicine, are driven by environmental factors that may exist at a household level (tobacco smoke exposure or solid fuel heating), community level (for instance, urban noise levels [8]) or municipal/city level ( pollen counts and heatwaves). Some work has identified neighbourhood as being a risk factor for poor compliance with continuous positive airway pressure therapy [9] but very few investigators have looked at what components of a neighbourhood might increase the risks of sleep apnoea itself.

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confidence: 99%

Completely scoobied: the confusing world of temperature and pollution effects on sleep apnoea

Marshall

Cowie

2015

Eur Respir J

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“…Our group has also previously shown that older age may exacerbate anatomical risk factors for OSA, and conversely, that a larger pharyngeal caliber is protective against OSA in older age (Carlisle et al. 2014). This is relevant for CHF patients because the prevalence of CHF increases markedly with advancing age (Scarborough et al.…”

Section: Discussionmentioning

confidence: 99%

Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

et al. 2017

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The increased prevalence of obstructive sleep apnea (OSA) in congestive heart failure (CHF) may be associated with rostral fluid shift. We investigated the effect of overnight rostral fluid shift on pharyngeal collapsibility (Pcrit), pharyngeal caliber (APmean), and apnea‐hypopnea index (AHI) in CHF patients. Twenty‐three optimally treated systolic CHF patients were studied. Neck circumference was measured immediately prior to sleep in the evening and immediately after waking in the morning as a marker of rostral fluid shift. Pcrit was measured during sleep, early and late in the night. APmean was measured using acoustic reflection at the same times as neck circumference measurements. 15/23 CHF patients experienced an overnight increase in neck circumference; overall neck circumference significantly increased overnight (mean±SD, evening: 41.7 ± 3.2 cm; morning: 42.3 ± 3.1 cm; P = 0.03). Pcrit increased significantly overnight (early‐night: −3.8 ± 3.3 cmH2O; late‐night: −2.6 ± 3.0 cmH2O; P = 0.03) and APmean decreased (evening: 4.2 ± 1.3 cm2; morning: 3.7 ± 1.3 cm2; P = 0.006). The total AHI correlated with neck circumference (r = 0.4; P = 0.04) and Pcrit (r = 0.5; P = 0.01). APmean correlated with neck circumference (r = −0.47; P = 0.02). There was no significant change in AHI between the first and second half of the night (first‐half: 12.9 ± 12.4/h; second‐half: 13.7 ± 13.3/h; P = 0.6). Overnight rostral fluid shift was associated with increased pharyngeal collapsibility and decreased pharyngeal caliber during sleep in CHF patients. Rostral fluid shift may be an important mechanism of OSA in this patient group.

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“…To explain the weak association between AHI, hypoxemia severity, and cardiac morphology and function in our sample of higher average age, we can suggest a possible interference of both physiological cardiac changes occurring with age and the presence of compensatory mechanisms to prevent increased upper airway collapsibility 22,23 in the elderly with SDB. It is known that the increased age-related collapsibility of the upper airways 24 explains a higher percentage of SDB, the rise in apnea-hypopnea duration, 25 and sometimes hypoxemia severity in the elderly.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Findings in Healthy Elderly People with Unrecognized Sleep Disordered Breathing

Sforza

Sabri

Dacosta

et al. 2015

Journal of Clinical Sleep Medicine

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Objective: Sleep disordered breathing (SDB) is associated with cardiovascular disease such as hypertension and left ventricular hypertrophy in middle-aged patients; however, this association is not well described in the elderly. The aim of this study was to evaluate the impact of unrecognized SDB on cardiac function and remodeling in a population-based sample of healthy elderly without cardiac disease. Methodology: A total of 405 healthy elderly (age ≥ 65 years) were examined by echocardiography and respiratory polygraphy. According to the apnea-hypopnea index (AHI), subjects were stratifi ed in four categories: snorers (AHI < 5), mild (AHI: 5-15), moderate (AHI: 15-30), and severe (AHI > 30) cases. Results: Comparative analysis between snorers and SDB cases revealed that left atrial (LA) diameter and surface increased according to SDB severity (p < 0.05) without differences in LA mass index. In subjects with an AHI > 30, an increase was found for LV end-diastolic and end-systolic dimension (p < 0.001), as well as for LV mass (p < 0.03) and LV index (p < 0.05). The current study showed a weak but signifi cant correlation between altered LA and LV measurements versus AHI and hypoxemia indices (p < 0.001). In the regression analysis, AHI and hypoxemia had a minimal effect, body mass index and male gender being the most signifi cant predictors. Conclusions: In a population of healthy elderly with SDB, slight changes in left atrial and ventricular measurements occur in severe cases (AHI > 30). Irrespective of the lack of a strong association between SDB and cardiac dysfunction, the presence of slight cardiac pathology in severe SDB cases might be considered. Clinical Trial Registration: NCT 00759304 and NCT 00766584. Keywords: sleep disordered breathing, hypoxemia, echocardiography, elderly, left cardiac function, obesity Citation: Sforza E, Sabri M, DaCosta A, Isaaz K, Barthélémy JC, Roche F. Echocardiographic fi ndings in healthy elderly people with unrecognized sleep disordered breathing. J Clin Sleep Med 2015;11(9):975-980.pii: jc-00437-14 http://dx.doi.org/10.5664/jcsm.5006 S leep disordered breathing (SDB) is a common disease in adults affecting 9% of women and 24% of men aged 30-60 years, with an even higher prevalence reported in the elderly population.1,2 Several clinical and epidemiological studies have established an association of SDB with increased incidence of hypertension, coronary heart disease, stroke, heart failure, and mortality after adjustment for cardiovascular risk factors. 3,4 Animal models using intermittent hypoxemia have demonstrated that chronic exposure to hypoxia induces cardiac disturbances including an increase in left ventricular (LV) mass, as well as an interstitial fi brosis in LV myocardium. 5,6An experimental model of intermittent hypoxemia mimics the repetitive nocturnal hypoxemia occurring in SDB patients, inducing increased sympathetic nervous system activity, oxidative stress, systemic infl ammation, 7 elevated cardiac fi lling, hemodynamic overload, and increased ventricular...

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Upper airway factors that protect against obstructive sleep apnoea in healthy older males

Cited by 30 publications

References 29 publications

Completely scoobied: the confusing world of temperature and pollution effects on sleep apnoea

Completely scoobied: the confusing world of temperature and pollution effects on sleep apnoea

Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

Echocardiographic Findings in Healthy Elderly People with Unrecognized Sleep Disordered Breathing

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