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

  • F Gao (a1) (a2), Y R Li (a1) (a2), W Xu (a1) (a2), Y S An (a1) (a2), H J Wang (a1) (a2), J F Xian (a3) and D M Han (a1) (a2)...



To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea.


A 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.


Soft 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.


A 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.


Corresponding author

Author for correspondence: Prof Han Demin, Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, No. 8 Chongwenmen Inner Street, Dongcheng District, Beijing, China E-mail:


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Prof H Demin takes responsibility for the integrity of the content of the paper



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1Peppard, PE, Young, T, Palta, M, Dempsey, J, Skatrud, J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015–2110.1001/jama.284.23.3015
2Peppard, PE, Young, T, Barnet, JH, Palta, M, Hagen, E, Hla, KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006–1410.1093/aje/kws342
3Marin, JM, Carrizo, SJ, Vicente, E, Agusti, AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046–5310.1016/S0140-6736(05)71141-7
4Somers, VK, White, DP, Amin, R, Abraham, WT, Costa, F, Culebras, A et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. Circulation 2008;118:1080–11110.1161/CIRCULATIONAHA.107.189420
5Jordan, AS, McSharry, DG, Malhotra, A. Adult obstructive sleep apnoea. Lancet 2014;383:736–4710.1016/S0140-6736(13)60734-5
6Schorr, F, Kayamori, F, Hirata, RP, Danzi-Soares, NJ, Gebrim, EM, Moriya, HT et al. Different craniofacial characteristics predict upper airway collapsibility in Japanese-Brazilian and white men. Chest 2016;149:737–4610.1378/chest.15-0638
7Barkdull, GC, Kohl, CA, Patel, M, Davidson, TM. Computed tomography imaging of patients with obstructive sleep apnea. Laryngoscope 2008;118:1486–9210.1097/MLG.0b013e3181782706
8Sutherland, K, Lee, RWW, Phillips, CL, Dungan, G, Yee, BJ, Magnussen, JS et al. Effect of weight loss on upper airway size and facial fat in men with obstructive sleep apnoea. Thorax 2011;66:79780310.1136/thx.2010.151613
9Berry, RB, Budhiraja, R, Gottlieb, DJ, Gozal, D, Iber, C, Kapur, VK et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:59761910.5664/jcsm.2172
10Sutherland, K, Phillips, CL, Yee, BJ, Grunstein, RR, Cistulli, PA. Maxillomandibular volume influences the relationship between weight loss and improvement in obstructive sleep apnea. Sleep 2016;39:43–910.5665/sleep.5314
11Burger, CD, Stanson, AW, Sheedy, PF 2nd, Daniels, BK, Shepard, JW Jr. Fast-computed tomography evaluation of age-related changes in upper airway structure and function in normal men. Am Rev Respir Dis 1992;145:846–5210.1164/ajrccm/145.4_Pt_1.846
12Mayer, 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;9:1801–910.1183/09031936.96.09091801
13Brown, IG, Zamel, N, Hoffstein, V. Pharyngeal cross-sectional area in normal men and women. J Appl Physiol (1985) 1986;61:890–510.1152/jappl.1986.61.3.890
14Huang, J, Shen, H, Takahashi, M, Fukunaga, T, Toga, H, Takahashi, K et al. Pharyngeal cross-sectional area and pharyngeal compliance in normal males and females. Respiration 1998;65:458–6810.1159/000029314
15Kollias, I, Krogstad, O. Adult craniocervical and pharyngeal changes--a longitudinal cephalometric study between 22 and 42 years of age. Part II: Morphological uvulo-glossopharyngeal changes. Eur J Orthod 1999;21:345–5510.1093/ejo/21.4.345
16Martin, SE, Mathur, R, Marshall, I, Douglas, NJ. The effect of age, sex, obesity and posture on upper airway size. Eur Respir J 1997;10:2087–9010.1183/09031936.97.10092087
17Malhotra, 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.e9–1410.1016/j.amjmed.2005.01.077
18Johnston, CD, Richardson, A. Cephalometric changes in adult pharyngeal morphology. Eur J Orthod 1999;21:357–6210.1093/ejo/21.4.357
19Lim, JS, Lee, JW, Han, C, Kwon, JW. Correlation of soft palate length with velum obstruction and severity of obstructive sleep apnea syndrome. Auris Nasus Larynx 2018;45:49950310.1016/j.anl.2017.07.023
20Julia-Serda, G, Perez-Penate, G, Saavedra-Santana, P, Ponce-Gonzalez, M, Valencia-Gallardo, JM, Rodriguez-Delgado, R et al. Usefulness of cephalometry in sparing polysomnography of patients with suspected obstructive sleep apnea. Sleep Breath 2006;10:181–710.1007/s11325-006-0073-y
21Borges Pde, T, Filho, ES, Araujo, TM, Neto, JM, Borges, NE, Neto, BM et al. Correlation of cephalometric and anthropometric measures with obstructive sleep apnea severity. Int Arch Otorhinolaryngol 2013;17:321–8
22George, JR, Chung, S, Nielsen, I, Goldberg, AN, Miller, A, Kezirian, EJ. Comparison of drug-induced sleep endoscopy and lateral cephalometry in obstructive sleep apnea. Laryngoscope 2012;122:2600–510.1002/lary.23561
23Trudo, FJ, Gefter, WB, Welch, KC, Gupta, KB, Maislin, G, Schwab, RJ. State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects. Am J Respir Crit Care Med 1998;158:1259–70
24Li, XD, Gao, XM, Zeng, XL. A magnetic resonance imaging research of upper airway and surrounding tissues of 83 non-snoring males [in Chinese]. Beijing Da Xue Xue Bao Yi Xue Ban 2005;37:190–4
25Ciscar, MA, Juan, G, Martinez, V, Ramon, M, Lloret, T, Minguez, J et al. Magnetic resonance imaging of the pharynx in OSA patients and healthy subjects. Eur Respir J 2001;17:798610.1183/09031936.01.17100790
26Welch, KC, Foster, GD, Ritter, CT, Wadden, TA, Arens, R, Maislin, G et al. A novel volumetric magnetic resonance imaging paradigm to study upper airway anatomy. Sleep 2002;25:532–4210.1093/sleep/25.5.530
27Carlisle, 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;44:685–9310.1183/09031936.00177213
28Genta, PR, Schorr, F, Eckert, DJ, Gebrim, E, Kayamori, F, Moriya, HT et al. Upper airway collapsibility is associated with obesity and hyoid position. Sleep 2014;37:1673–810.5665/sleep.4078
29Miles, PG, Vig, PS, Weyant, RJ, Forrest, TD, Rockette, HE Jr.Craniofacial structure and obstructive sleep apnea syndrome--a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop 1996;109:163–7210.1016/S0889-5406(96)70177-4
30Nelson, S, Hans, M. Contribution of craniofacial risk factors in increasing apneic activity among obese and nonobese habitual snorers. Chest 1997;111:154–62
31Thurnheer, R, Wraith, PK, Douglas, NJ. Influence of age and gender on upper airway resistance in NREM and REM sleep. J Appl Physiol (1985) 2001;90:981–810.1152/jappl.2001.90.3.981
32Lin, CM, Davidson, TM, Ancoli-Israel, S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev 2008;12:481–9610.1016/j.smrv.2007.11.003
33Young, T, Finn, L, Austin, D, Peterson, A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 2003;167:1181–510.1164/rccm.200209-1055OC
34Bixler, 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;163:608–1310.1164/ajrccm.163.3.9911064
35Chousangsuntorn, K, Bhongmakapat, T, Apirakkittikul, N, Sungkarat, W, Supakul, N, Laothamatas, J. Upper airway areas, volumes, and linear measurements determined on computed tomography during different phases of respiration predict the presence of severe obstructive sleep apnea. J Oral Maxillofac Surg 2018;76:1524–3110.1016/j.joms.2017.11.041
36Chen, NH, Lin, SW, Chuang, LP, Cistulli, PA, Hsieh, MJ, Kao, KC et al. Pharyngeal distensibility during expiration is an independent predictor of the severity of obstructive sleep apnoea. Respirology 2019;24:582–9


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

  • F Gao (a1) (a2), Y R Li (a1) (a2), W Xu (a1) (a2), Y S An (a1) (a2), H J Wang (a1) (a2), J F Xian (a3) and D M Han (a1) (a2)...


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