Advertisement

Current Sleep Medicine Reports

, Volume 4, Issue 4, pp 294–299 | Cite as

The Influence of Gender and Age on Upper Airway Reflexes

  • James A. Rowley
Sleep Related Breathing Disorders (L Kheirandish-Gozal, Section Editor)
  • 11 Downloads
Part of the following topical collections:
  1. Topical Collection on Sleep Related Breathing Disorders

Abstract

Purpose of Review

Differences in upper airway collapsibility are thought to underlie the observations that obstructive sleep apnea (OSA) is more common in men and in older individuals. Baseline neuromuscular activity and upper airway reflexes are two of the determinants of upper airway size and collapsibility and gender and aging differences in these determinants could explain, in part, differences in OSA prevalence. The purpose of this review is to review the influence of gender and age on upper airway reflexes.

Recent Findings

Most recent findings indicate that aging is associated with both changes in baseline neuromuscular activity of the genioglossus muscle (when studied as muscle unit potentials) and is associated with impairment in upper airway reflexes, particularly the perception response to inspiratory loading.

Summary

The limited data on gender differences in upper airway reflexes shows no difference in the negative pressure reflex or relationship between epiglottic pressure and genioglossus activity. Thus, gender differences in upper airway collapsibility are probably not explained by differences in upper airway reflexes. In contrast, there is evidence that upper airway reflexes are impaired with aging and these impairments might contribute to the increased collapsibility of the upper airway observed in some, though not all, studies of older subjects.

Keywords

Gender Upper airway Upper airway reflexes Upper airway collapsibility Obstructive sleep apnea 

Notes

Compliance with Ethical Standards

Conflict of Interest

James A. Rowley declares no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    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.CrossRefGoogle Scholar
  2. 2.
    Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163:608–13.CrossRefGoogle Scholar
  3. 3.
    Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006–14.CrossRefGoogle Scholar
  4. 4.
    Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998; 157: 144–148.CrossRefGoogle Scholar
  5. 5.
    Haponik EF, Smith PL, Bohlman ME, Allen RP, Goldman SM, Bleecker ER. Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis. 1983;127:221–6.PubMedGoogle Scholar
  6. 6.
    Pillar G, Malhotra A, Fogel R, Beauregard J, Schnall R, White DP. Airway mechanics and ventilation in response to resistive loading during sleep: influence of gender. Am J Respir Crit Care Med. 2000;162:1627–32.CrossRefGoogle Scholar
  7. 7.
    Trinder J, Kay A, Kleiman J, Dunai J. Gender differences in airway resistance during sleep. J Appl Physiol. 1997;83:1986–97.CrossRefGoogle Scholar
  8. 8.
    Rowley JA, Zhou X, Vergine I, Shkoukani MA, Badr MS. Influence of gender on upper airway mechanics: upper airway resistance and Pcrit. J Appl Physiol. 2001;91:2248–54.CrossRefGoogle Scholar
  9. 9.
    Brown IG, Zamel N, Hoffstein V. Pharyngeal cross-sectional area in normal men and women. J Appl Physiol. 1986;61:890–5.CrossRefGoogle Scholar
  10. 10.
    Brooks LJ, Strohl KP. Size and mechanical properties of the pharynx in healthy men and women. Am Rev Respir Dis. 1992;146:1394–7.CrossRefGoogle Scholar
  11. 11.
    Martin SE, Mathur R, Marshall I, Douglas NJ. The effect of age, sex, obesity and posture on upper airway size. Eur Respir J. 1997;10:2087–90.CrossRefGoogle Scholar
  12. 12.
    Rowley JA, Sanders CS, Zahn BR, Badr MS. Gender differences in upper airway compliance during NREM sleep: role of neck circumference. J Appl Physiol. 2002;92:2535–41.CrossRefGoogle Scholar
  13. 13.
    Browne HA, Adams L, Simonds AK, Morrell MJ. Impact of age on breathing and resistive pressure in people with and without sleep apnea. J Appl Physiol. 2001;90:1074–82.CrossRefGoogle Scholar
  14. 14.
    Thurnheer R, Wraith PK, Douglas NJ. Influence of age and gender on upper airway resistance in NREM and REM sleep. J Appl Physiol. 2001;90:981–8.CrossRefGoogle Scholar
  15. 15.
    Eikermann M, Jordan AS, Chamberlin NL, Gautam S, Wellman A, Lo YL, et al. The influence of aging on pharyngeal collapsibility during sleep. Chest. 2007;131:1702–9.CrossRefGoogle Scholar
  16. 16.
    Mayer P, Pepin JL, Bettega G, Veale D, Ferretti G, Deschaux C, et al. Relationship between body mass index, age and upper airway measurements in snorers and sleep apnoea patients. Eur Respir J. 1996;9:1801–9.CrossRefGoogle Scholar
  17. 17.
    • Carlisle T, Carthy ER, Glasser M, Drivas P, McMillan A, Cowie MR, et al. Upper airway factors that protect against obstructive sleep apnoea in healthy older males. Eur Respir J. 2014;44:685–93 Study investigated differences in MRI and acoustic reflectance measurements of the upper airway, finding larger pharyngeal caliber and volume in older males. CrossRefGoogle Scholar
  18. 18.
    Malhotra A, Huang Y, Fogel R, Lazic S, Pillar G, Jakab M, et al. Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med. 2006;119:72–14.CrossRefGoogle Scholar
  19. 19.
    Kirkness JP, Schwartz AR, Schneider H, Punjabi NM, Maly JJ, Laffan AM, et al. Contribution of male sex, age, and obesity to mechanical instability of the upper airway during sleep. J Appl Physiol. 2008;104:1618–24.CrossRefGoogle Scholar
  20. 20.
    Patil SP, Schneider H, Marx JJ, Gladmon E, Schwartz AR, Smith PL. Neuromechanical control of upper airway patency during sleep. J Appl Physiol. 2007;102:547–56.CrossRefGoogle Scholar
  21. 21.
    Tangel DJ, Mezzanotte WS, White DP. Influences of NREM sleep on activity of palatoglossus and levator palatini muscles in normal men. J Appl Physiol. 1995;78:689–95.CrossRefGoogle Scholar
  22. 22.
    Tangel DJ, Mezzanotte WS, White DP. Influence of sleep on tensor palatini EMG and upper airway resistance in normal men. J Appl Physiol. 1991;70:2574–81.CrossRefGoogle Scholar
  23. 23.
    Wiegand DA, Latz B, Zwillich CW, Wiegand L. Geniohyoid muscle activity in normal men during wakefulness and sleep. J Appl Physiol. 1990;69:1262–9.CrossRefGoogle Scholar
  24. 24.
    Eckert DJ, Malhotra A, Lo YL, White DP, Jordan AS. The influence of obstructive sleep apnea and gender on genioglossus activity during rapid eye movement sleep. Chest. 2009;135:957–64.CrossRefGoogle Scholar
  25. 25.
    Wiegand L, Zwillich CW, Wiegand D, White DP. Changes in upper airway muscle activation and ventilation during phasic REM sleep in normal men. J Appl Physiol. 1991;71:488–97.CrossRefGoogle Scholar
  26. 26.
    Popovic RM, White DP. Influence of gender on waking genioglossal electromyogram and upper airway resistance. Am J Respir Crit Care Med. 1995;152:725–31.CrossRefGoogle Scholar
  27. 27.
    Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol. 1998;84:1055–62.CrossRefGoogle Scholar
  28. 28.
    Jordan AS, Catcheside PG, O'Donoghue FJ, Saunders NA, McEvoy RD. Genioglossus muscle activity at rest and in response to brief hypoxia in healthy men and women. J Appl Physiol (1985). 2002;92:410–7.CrossRefGoogle Scholar
  29. 29.
    Pae EK, Blasius JJ, Nanda R. Sex differences in genioglossus muscle response to changes in pharyngeal resistance. Am J Orthod Dentofac Orthop. 2002;122:500–5.CrossRefGoogle Scholar
  30. 30.
    Horner RL, Innes JA, Holden HB, Guz A. Afferent pathway(s) for pharyngeal dilator reflex to negative pressure in man: a study using upper airway anaesthesia. J Physiol. 1991;436:31–44.CrossRefGoogle Scholar
  31. 31.
    Wheatley JR, Mezzanotte WS, Tangel DJ, White DP. Influence of sleep on genioglossus muscle activation by negative pressure in normal men. Am Rev Respir Dis. 1993;148:597–605.CrossRefGoogle Scholar
  32. 32.
    Wheatley JR, Tangel DJ, Mezzanotte WS, White DP. Influence of sleep on response to negative airway pressure of tensor palatini muscle and retropalatal airway. J Appl Physiol. 1993;75:2117–24.CrossRefGoogle Scholar
  33. 33.
    Horner RL, Innes JA, Murphy K, Guz A. Evidence for reflex upper airway dilator muscle activation by sudden negative airway pressure in man. J Physiol. 1991;436:15–29.CrossRefGoogle Scholar
  34. 34.
    Shea SA, Edwards JK, White DP. Effect of wake-sleep transitions and rapid eye movement sleep on pharyngeal muscle response to negative pressure in humans. J Physiol. 1999;520(Pt 3):897–908.CrossRefGoogle Scholar
  35. 35.
    White DP, Edwards JK, Shea SA. Local reflex mechanisms: influence on basal genioglossal muscle activation in normal subjects. Sleep. 1998;21:719–28.CrossRefGoogle Scholar
  36. 36.
    Fogel RB, White DP, Pierce RJ, Malhotra A, Edwards JK, Dunai J, et al. Control of upper airway muscle activity in younger versus older men during sleep onset. J Physiol. 2003;553:533–44.CrossRefGoogle Scholar
  37. 37.
    Saboisky JP, Stashuk DW, Hamilton-Wright A, Carusona AL, Campana LM, Trinder J, et al. Neurogenic changes in the upper airway of patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2012;185:322–9.CrossRefGoogle Scholar
  38. 38.
    • Saboisky JP, Stashuk DW, Hamilton-Wright A, Trinder J, Nandedkar S, Malhotra A. Correction: effects of aging on genioglossus motor units in human. PLoS One. 2016;11:e0164252 Studying the motor unit potential of the genioglossal muscle, authors show that older men have more neurogenic changes than younger men; these neurogenic changes are similar to those seen in subjects with OSA, suggesting that they may contribute to impair upper airway neuromuscular activity in older men. CrossRefGoogle Scholar
  39. 39.
    Klawe JJ, Tafil-Klawe M. Age-related response of the genioglossus muscle EMG-activity to hypoxia in humans. J Physiol Pharmacol. 2003;54(Suppl 1):14–9.PubMedGoogle Scholar
  40. 40.
    • Murtolahti S, Crouse UK, Pahkala R, Warren DW, Laine-Alava MT. Perception and respiratory responses of the upper airway mechanism to added resistance with aging. Laryngoscope Investig Otolaryngol. 2017;2:417–22 Study confirms that older subjects have impaired perception of the pressure changes associated with inspiratory loading; this finding is consistent with others that upper airway reflexes are impaired with aging. CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineWayne State University School of MedicineDetroitUSA

Personalised recommendations