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The aging effect on upper airways collapse of patients with obstructive sleep apnea syndrome

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate, using drug-induced sleep endoscopy (DISE), sites of upper airway obstruction and pattern of collapse in patients over 65 years old affected by obstructive sleep apnea. To compare sites and pattern of collapse of elderly patients with a group of patients younger than 65 years.

Methods

A group of 55 patients aged over 65 years were enrolled in this prospective study. Fifty patients under 65 years old were collected in the control group. Polysomnographic data and clinical parameters such as the daytime sleepiness, and body mass index were evaluated for both groups of patients. All patients underwent DISE examination with VOTE classification.

Results

The AHI value increased with aging whereas elderly patients presented a reduction in daytime sleepiness. Elderly patients showed a higher incidence of total collapse in the velum region compared to younger patients (90.9% vs 70%;); the older patients showed a lower degree of total oropharyngeal lateral wall collapse with respect to younger patients, (20% vs 50%). No difference in tongue base collapse emerged between the two subgroups of patients.

Conclusion

Elderly patients showed a higher incidence of total collapse in the velum and a lower incidence in the oropharyngeal lateral wall compared to younger patients.

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References

  1. Bosi M, De Vito A, Gobbi R, Poletti V, Vicini C (2017) The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy. Eur Arch Otorhinolaryngol 274:1251–1261

    Article  Google Scholar 

  2. Magliulo G, de Vincentiis M, Iannella G et al (2018) Eustachian tube evaluation in patients with obstructive sleep apnea syndrome. Acta Otolaryngol 138:159–164

    Article  Google Scholar 

  3. Shochat T, Pillar G (2003) Sleep apnoea in the older adult: pathophysiology, epidemiology, consequences and management. Drugs Aging 20:551–560

    Article  Google Scholar 

  4. Young T, Shahar E, Nieto FJ et al (2002) Predictors of sleep-disordered breathing in community-dwelling adults: the sleep heart health study. Arch Intern Med 162:893–900

    Article  Google Scholar 

  5. Magliulo G, De Vincentiis M, Iannella G et al (2018) Olfactory evaluation in obstructive sleep apnoea patients. Acta Otorhinolaryngol Ital 38:338–345

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Yaremchuk K (2018) Sleep disorders in the elderly. Clin Geriatr Med 34:205–216

    Article  Google Scholar 

  7. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O (1991) Sleep-disordered breathing in community-dwelling elderly. Sleep 14:486–495

    Article  CAS  Google Scholar 

  8. Ancoli-Israel S, Kripke DF, Klauber MR et al (1996) Morbidity, mortality and sleep-disordered breathing in community dwelling elderly. Sleep 19:277–282

    Article  CAS  Google Scholar 

  9. Morrell MJ, Finn L, McMillan A, Peppard PE (2012) The impact of ageing and sex on the association between sleepiness and sleep disordered breathing. Eur Respir J 40:386–393

    Article  Google Scholar 

  10. McMillan A, Morrell MJ (2016) Sleep disordered breathing at the extremes of age: the elderly. Breathe (Sheff) 12:50–60

    Article  Google Scholar 

  11. Suzuki K, Miyamoto M, Hirata K (2017) Sleep disorders in the elderly: diagnosis and management. J Gen Fam Med 18:61–71

    Article  Google Scholar 

  12. Ahmad N, Srinivasan K, Naicker TR, Moudgil H (2014) Sleep apnoea in the elderly. Lancet Respir Med 2:21

    Article  Google Scholar 

  13. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014

    Article  Google Scholar 

  14. Carlisle T, Carthy ER, Glasser M et al (2014) Upper airway factors that protect against obstructive sleep apnoea in healthy older males. Eur Respir J 44:685–693

    Article  Google Scholar 

  15. Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI (1995) Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 152:1673–1689

    Article  CAS  Google Scholar 

  16. Malhotra A, Huang Y, Fogel R et al (2006) Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med 119:9–14

    Article  Google Scholar 

  17. Jang MS, Kim HY, Dhong HJ et al (2014) Effect of parapharyngeal fat on dynamic obstruction of the upper airway in patients with obstructive sleep apnea. Am J Respir Crit Care Med 190:1318–1321

    Article  Google Scholar 

  18. Bosi M, De Vito A, Vicini C, Poletti V (2017) The role of compact polysomnography/polygraphy in sleep breathing disorder patients’ management. Eur Arch Otorhinolaryngol 274:2013–2028

    Article  Google Scholar 

  19. De Vito A, Carrasco Llatas M, Ravensloot M et al. (2018) European position paper on drug-induced sleep endoscopy (DISE): 2017 update. Clin Otolaryngol. https://doi.org/10.1111/coa.13213

    Article  PubMed  Google Scholar 

  20. Charakorn N, Kezirian EJ (2016) Drug-induced sleep endoscopy. Otolaryngol Clin North Am 49:1359–1372

    Article  Google Scholar 

  21. Campanini A, Canzi P, De Vito A, Dallan I, Montevecchi F, Vicini C (2010) Awake versus sleep endoscopy: personal experience in 250 OSAHS patients. Acta Otorhinolaryngol Ital 30:73–77

    CAS  PubMed  PubMed Central  Google Scholar 

  22. De Vito A, Agnoletti V, Zani G et al (2017) The importance of drug-induced sedation endoscopy (D.I.S.E.) techniques in surgical decision making: conventional versus target controlled infusion techniques-a prospective randomized controlled study and a retrospective surgical outcomes analysis. Eur Arch Otorhinolaryngol 274:2307–2317

    Article  Google Scholar 

  23. Koo SK, Choi JW, Myung NS, Lee HJ, Kim YJ, Kim YJ (2013) Analysis of obstruction site in obstructive sleep apnea syndrome patients by drug induced sleep endoscopy. Am J Otolaryngol 34:626–630

    Article  Google Scholar 

  24. Ravesloot MJ, de Vries N (2011) One hundred consecutive patients undergoing drug-induced sleep endoscopy: results and evaluation. Laryngoscope 121:2710–2716

    Article  Google Scholar 

  25. Golbin D, Musgrave B, Succar E, Yaremchuk K (2016) Clinical analysis of drug-induced sleep endoscopy for the OSA patient. Laryngoscope 126:249–253

    Article  Google Scholar 

  26. Richard B, Berry R, Brooks CE, Gamaldo et al (2015) AASM manual for the scoring of sleep and associated events. American Academy of Sleep Medicine, Darien

    Google Scholar 

  27. Epstein LJ, Kristo D, Strollo PJ Jr et al (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–276

    PubMed  Google Scholar 

  28. De Vito A, Carrasco Llatas M, Vanni A et al (2014) European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath 18:453–465

    Article  Google Scholar 

  29. De Vito A, Agnoletti V, Berrettini S et al (2011) Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques—a randomized controlled study. Eur Arch Otorhinolaryngol 268:457–462

    Article  Google Scholar 

  30. Lo YL, Ni YL, Wang TY et al (2015) Bispectral index in evaluating effects of sedation depth on drug-induced sleep endoscopy. J Clin Sleep Med 11:1011–1020

    PubMed  PubMed Central  Google Scholar 

  31. Traxdorf M, Tschaikowsky K, Scherl C, Bauer J, Iro H, Angerer F (2016) Drug-induced sleep endoscopy (DISE) with target controlled infusion (TCI) and bispectral analysis in obstructive sleep apnea. J Vis Exp 6:18

    Google Scholar 

  32. Kezirian EJ, Hohenhorst W, de Vries N (2011) Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 268:1233–1236

    Article  Google Scholar 

  33. Levendowski DJ, Oksenberg A, Vicini C, Penzel T, Levi M, Westbrook PR (2018) A systematic comparison of factors that could impact treatment recommendations for patients with positional obstructive sleep apnea (POSA). Sleep Med 50:145–151

    Article  Google Scholar 

  34. Safiruddin F, Koutsourelakis I, de Vries N (2014) Analysis of the influence of head rotation during drug-induced sleep endoscopy in obstructive sleep apnea. Laryngoscope 124:2195–2199

    Article  Google Scholar 

  35. George E, Katerina V, Maria S, Lambros B, Konstantina N, Dimitrios G (2012) Clinical features and polysomnographic findings in greek male patients with obstructive sleep apnea syndrome: differences regarding the age. Sleep Disord 2012:324

    Article  Google Scholar 

  36. Heinzer RC, Stanchina ML, Malhotra A et al (2006) Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax 61:435–439

    Article  CAS  Google Scholar 

  37. Torre C, Camacho M, Liu SY, Huon LK, Capasso R (2016) Epiglottis collapse in adult obstructive sleep apnea: a systematic review. Laryngoscope 126:515–523

    Article  Google Scholar 

  38. Gouveia CJ, Cramer JD, Liu SY, Capasso R (2017) Sleep surgery in the elderly: lessons from the national surgical quality improvement program. Otolaryngol Head Neck Surg 156:757–764

    Article  Google Scholar 

  39. Wilhelm CP, deShazo RD, Tamanna S, Ullah MI, Skipworth LB (2015) The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol 115:96–102

    Article  Google Scholar 

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Correspondence to Giannicola Iannella.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies were in accordance with the ethical standards of the institutional committee of the Morgagni Pierantoni Hospital and with the 1964 Helsinki declaration.

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Informed consent was obtained from all individual participants included in the study.

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Vicini, C., De Vito, A., Iannella, G. et al. The aging effect on upper airways collapse of patients with obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 275, 2983–2990 (2018). https://doi.org/10.1007/s00405-018-5163-5

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  • DOI: https://doi.org/10.1007/s00405-018-5163-5

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