Contribution of male sex, age, and obesity to mechanical instability of the upper airway during sleep

Journal of Applied Physiology

Volumn 104, Issue 6, 2008, Pages 1618-1624

  Kirkness, Jason P ^a,b   Schwartz, Alan R ^a   Schneider, Hartmut ^a   Punjabi, Naresh M ^a   Maly, Joseph J ^a   Laffan, Alison M ^a   McGinley, Brian M ^a   Magnuson, Thomas ^a   Schweitzer, Michael ^a   Smith, Philip L ^a   Patil, Susheel P ^a,c  

^a JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF WESTERN AUSTRALIA   (Australia)

^c JOHNS HOPKINS ASTHMA AND ALLERGY CENTER   (United States)

Author keywords

Obstructive sleep apnea; Pharynx; Physiopathology

Indexed keywords

ADULT; AGE; AGED; AIRWAY CONDUCTANCE; ARTICLE; CONTROLLED STUDY; DISEASE PREDISPOSITION; DISEASE SEVERITY; FEMALE; GENDER; HUMAN; MAJOR CLINICAL STUDY; MALE; OBESITY; PATHOPHYSIOLOGY; PHARYNX; PRIORITY JOURNAL; RISK FACTOR; SLEEP; SLEEP APNEA SYNDROME; UPPER RESPIRATORY TRACT; BODY MASS; BREATHING MECHANICS; COMPARATIVE STUDY; CROSS-SECTIONAL STUDY; HOSPITALIZATION; MIDDLE AGED; POLYSOMNOGRAPHY; SEX DIFFERENCE;

ADULT; AGE FACTORS; AGED; BODY MASS INDEX; CROSS-SECTIONAL STUDIES; FEMALE; HUMANS; MALE; MIDDLE AGED; OBESITY; PHARYNX; POLYSOMNOGRAPHY; RESPIRATORY MECHANICS; RISK FACTORS; SEVERITY OF ILLNESS INDEX; SEX FACTORS; SLEEP; SLEEP APNEA, OBSTRUCTIVE;

EID: 49649118004     PISSN: 87507587     EISSN: 15221601     Source Type: Journal    
DOI: 10.1152/japplphysiol.00045.2008     Document Type: Article

References (62)

1. Ahmad D, Morgan WK. Obesity and lung function. Thorax 56: 740-741, 2001.
2. Atlas Task Force. EEG arousals: scoring rules and examples. A preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15: 174-184, 1992.
3. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, Kales A. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 163: 608-613, 2001.
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 157: 144-148, 1998.
5. Borkan GA, Hults DE, Gerzof SG, Robbins AH, Silbert CK. Age changes in body composition revealed by computed tomography. J Gerontol 38: 673-677, 1983.
6. Boudewyns A, Punjabi N, Van de Heyning PH, De Backer WA, O'Donnell CP, Schneider H, Smith PL, Schwartz AR. Abbreviated method for assessing upper airway function in obstructive sleep apnea. Chest 118: 1031-1041, 2000.
7. Bradley TD, Brown IG, Grossman RF, Zamel N, Martinez D, Phillipson EA, Hoffstein V. Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea. N Engl J Med 315: 1327-1331, 1986.
8. Bromberger JT, Matthews KA, Kuller LH, Wing RR, Meilahn EN, Plantinga P. Prospective study of the determinants of age at menopause. Am J Epidemiol 145: 124-133, 1997.
9. Colombel A, Charbonnel B. Weight gain and cardiovascular risk factors in the post-menopausal women. Hum Reprod 12, Suppl 1: 134-145, 1997.
10. Dancey DR, Hanly PJ, Soong C, Lee B, Shepard J Jr, Hoffstein V. Gender differences in sleep apnea: the role of neck circumference. Chest 123: 1544-1550, 2003.
11. Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 163: 685-689, 2001.
12. Eastwood PR, Platt PR, Shepherd K, Maddison K, Hillman DR. Collapsibility of the upper airway at different concentrations of propofol anesthesia. Anesthesiology 103: 470-477, 2005.
13. Eastwood PR, Szollosi I, Platt PR, Hillman DR. Collapsibility of the upper airway during anesthesia with isoflurane. Anesthesiology 97: 786-793, 2002.
14. Eastwood PR, Szollosi I, Platt PR, Hillman DR. Comparison of upper airway collapse during general anaesthesia and sleep. Lancet 359: 1207-1209, 2002.
15. Gold EB, Bromberger J, Crawford S, Samuels S, Greendale GA, Harlow SD, Skurnick J. Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am J Epidemiol 153: 865-874, 2001.
16. Harik-Khan RI, Wise RA, Fleg JL. The effect of gender on the relationship between body fat distribution and lung function. J Clin Epidemiol 54: 399-406, 2001.
17. Heinzer RC, Stanchina ML, Malhotra A, Fogel RB, Patel SR, Jordan AS, Schory K, White DP. Lung volume and continuous positive airway pressure requirements in obstructive sleep apnea. Am J Respir Crit Care Med 172: 114-117, 2005.
18. Heinzer RC, Stanchina ML, Malhotra A, Jordan AS, Patel SR, Lo YL, Wellman A, Schory K, Dover L, White DP. Effect of increased lung volume on sleep disordered breathing in sleep apnoea patients. Thorax 61: 435-439, 2006.
19. Hillman DR, Platt PR, Eastwood PR. The upper airway during anaesthesia. Br J Anaesth 91: 31-39, 2003.
20. Hoffstein V, Zamel N, Phillipson EA. Lung volume dependence of pharyngeal cross-sectional area in patients with obstructive sleep apnea. Am Rev Respir Dis 130: 175-178, 1984.
21. Horner RL. Contributions of passive mechanical loads and active neuromuscular compensation to upper airway collapsibility during sleep. J Appl Physiol 102: 510-512, 2007.
22. Isono S, Morrison DL, Launois SH, Feroah TR, Whitelaw WA, Remmers JE. Static mechanics of the velopharynx of patients with obstructive sleep apnea. J Appl Physiol 75: 148-154, 1993.
23. Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of the pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 82: 1319-1326, 1997.
24. Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest 130: 827-833, 2006.
25. Jordan AS, Wellman A, Edwards JK, Schory K, Dover L, MacDonald M, Patel SR, Fogel RB, Malhotra A, White DP. Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea. J Appl Physiol 99: 2020-2027, 2005.
26. Kairaitis K, Parikh R, Stavrinou R, Garlick S, Kirkness JP, Wheatley JR, Amis TC. Upper airway extraluminal tissue pressure fluctuations during breathing in rabbits. J Appl Physiol 95: 1560-1566, 2003.
27. Kairaitis K, Stavrinou R, Parikh R, Wheatley JR, Amis TC. Mandibular advancement decreases pressures in the tissues surrounding the upper airway in rabbits. J Appl Physiol 100: 349-356, 2006.
28. Kirkness JP, Madronio M, Stavrinou R, Wheatley JR, Amis TC. Relationship between surface tension of upper airway lining liquid and upper airway collapsibility during sleep in obstructive sleep apnea hypopnea syndrome. J Appl Physiol 95: 1761-1766, 2003.
29. Kirkness JP, Patil SP, Schneider H, Pichard LE, Maly JJ, McGinley BM, Lafan AM, Magnuson T, Schweitzer T, Lidor AO, Smith PL, Schwartz AR. Women are protected against obstructive sleep apnea through reduced upper airway mechanical loads and active neuromuscular responses (Abstract). Proc Am Thorac Soc 3: A314, 2006.
30. Kirkness JP, Patil SP, Schneider H, Smith PL, Schwartz AR. Obesity augments passive mechanical load on the upper airway in men but not women (Abstract). Sleep Biol Rhythms 4: A18, 2006.
31. Malhotra A, Huang Y, Fogel RB, Pillar G, Edwards JK, Kikinis R, Loring SH, White DP. The male predisposition to pharyngeal collapse: importance of airway length. Am J Respir Crit Care Med 166: 1388-1395, 2002.
32. Morabia A, Costanza MC. International variability in ages at menarche, first livebirth, and menopause. World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives. Am J Epidemiol 148: 1195-1205, 1998.
33. Mortimore IL, Marshall I, Wraith PK, Sellar RJ, Douglas NJ. Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 157: 280-283, 1998.
34. Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight: the sleep heart health study. Arch Intern Med 165: 2408-2413, 2005.
35. Oliven A, Carmi N, Coleman R, Odeh M, Silbermann M. Age-related changes in upper airway muscles morphological and oxidative properties. Exp Gerontol 36: 1673-1686, 2001.
36. Patil SP, Punjabi NM, Schneider H, O'Donnell CP, Smith PL, Schwartz AR. A simplified method for measuring critical pressures during sleep in the clinical setting. Am J Respir Crit Care Med 170: 86-93, 2004.
37. Patil SP, Schneider H, Marx JJ, Gladmon E, Schwartz AR, Smith PL. Neuromechanical control of upper airway patency during sleep. J Appl Physiol 102: 547-556, 2007.
38. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284: 3015-3021, 2000.
39. 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 162: 1627-1632, 2000.
40. Punjabi NM, O'Hearn DJ, Neubauer DN, Nieto FJ, Schwartz AR, Smith PL, Bandeen-Roche K. Modeling hypersomnolence in sleep-disordered breathing A novel approach using survival analysis. Am J Respir Crit Care Med 159: 1703-1709, 1999.
41. Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles, CA: Brain Information Service/Brain Research Institute, 1968.
42. Redline S, Kump K, Tishler PV, Browner I, Ferrette V. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 149: 722-726, 1994.
43. Rowley JA, Permutt S, Willey S, Smith PL, Schwartz AR. Effect of tracheal and tongue displacement on upper airway airflow dynamics. J Appl Physiol 80: 2171-2178, 1996.
44. Rowley JA, Sanders CS, Zahn BR, Badr MS. Gender differences in upper airway compliance during NREM sleep: role of neck circumference. J Appl Physiol 92: 2535-2541, 2002.
45. 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 91: 2248-2254, 2001.
46. Schwab RJ, Pasirstein M, Kaplan L, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI. Family aggregation of upper airway soft tissue structures in normal subjects and patients with sleep apnea. Am J Respir Crit Care Med 173: 453-463, 2006.
47. Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 168: 522-530, 2003.
48. Schwartz AR, Gold AR, Schubert N, Stryzak A, Wise RA, Permutt S, Smith PL. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis 144: 494-498, 1991.
49. Schwartz AR, O'Donnell CP, Baron J, Schubert N, Alam D, Samadi SD, Smith PL. The hypotonic upper airway in obstructive sleep apnea: role of structures and neuromuscular activity. Am J Respir Crit Care Med 157: 1051-1057, 1998.
50. Schwartz AR, Schubert N, Rothman W, Godley F, Marsh B, Eisele D, Nadeau J, Permutt L, Gleadhill I, Smith PL. Effect of uvulopalatopharyngoplasty on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis 145: 527-532, 1992.
51. Schwartz AR, Smith PL, Wise RA, Gold AR, Permutt S. Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure. J Appl Physiol 64: 535-542, 1988.
52. Series F, Cormier Y, Desmeules M. Influence of passive changes of lung volume on upper airways. J Appl Physiol 68: 2159-2164, 1990.
53. Smith AH, Kark JD, Cassel JC, Spears GF. Analysis of prospective epidemiologic studies by minimum distance case-control matching. Am J Epidemiol 105: 567-574, 1977.
54. Smith PL, Wise RA, Gold AR, Schwartz AR, Permutt S. Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 64: 789-795, 1988.
55. Tagaito Y, Isono S, Nishino T. Upper airway reflexes during a combination of propofol and fentanyl anesthesia. Anesthesiology 88: 1459-1466, 1998.
56. Thut DC, Schwartz AR, Roach D, Wise RA, Permutt S, Smith PL. Tracheal and neck position influence upper airway airflow dynamics by altering airway length. J Appl Physiol 75: 2084-2090, 1993.
57. Ware JC, McBrayer RH, Scott JA. Influence of sex and age on duration and frequency of sleep apnea events. Sleep 23: 165-170, 2000.
58. Wilhoit SC, Suratt PM. Obstructive sleep apnea in premenopausal women. A comparison with men and with postmenopausal women. Chest 91: 654-658, 1987.
59. Winter WC, Gampper T, Gay SB, Suratt PM. Lateral pharyngeal fat pad pressure during breathing in anesthetized pigs. J Appl Physiol 83: 688-694, 1997.
60. Younes M. Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea. Am J Respir Crit Care Med 168: 645-658, 2003.
61. 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 328: 1230-1235, 1993.
62. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 162: 893-900, 2002.