Upper airway morphological changes in obstructive sleep apnoea: effect of age on pharyngeal anatomy

Abstract

ObjectiveTo evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea.MethodsA total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed.ResultsSoft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2.ConclusionA number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.

The Predictive Role of the Upper-Airway Adipose Tissue in the Pathogenesis of Obstructive Sleep Apnoea

“…Chen et al detected a significant correlation between AHI and the subglosso-supraglottic-level parapharyngeal fat pad, independently of BMI and neck circumference parameters [ 51 ]. According to Gao et al, in patients with a BMI over 28 kg/m 2 , a significant positive effect of age on parapharyngeal AT volumes was detected [ 52 ].…”

<p>Quantitative Morphometric Measurements of the Oropharynx in Obstructive Sleep Apnea Syndrome Using a Laser Depth Measurement Module</p>

“… 13 A study by Gao et al found that the volume of the retropalatal region increased with aging. 14 The authors hypothesized that the aging effect could reduce the tone of the soft palate muscle, increase the soft palate length and shrink the tonsils. In the current study, the oropharyngeal size showed no significant relationship with age.…”

Obstructive sleep apnea and perioperative management of the difficult airway

“…20,21 Aging is also associated with an increased risk of OSA. 9 Elderly patients tend to have a longer pharyngeal airway due to increased length of the soft palate, 22 an inferiorly located hyoid bone, a smaller cross-sectional area at the retropalatal and retroglossal regions, 23 and an increased parapharyngeal fat pad volume. 22 These changes can result in increased airway resistance and, therefore, increase the risk of airway collapse.…”