The effect of aging on drug-induced sleep endoscopy findings

Abstract

Objectives/hypothesis: To evaluate the correlation of aging and upper airway collapse characteristics observed by drug-induced sleep endoscopy (DISE), and report the observed differences on obstructive sleep apnea (OSA) subjects, older and younger than 60 years.

Study design: Case series.

Methods: This study analyzed the data of 200 OSA patients who underwent DISE between January 1, 2013 and June 30, 2017. The variables sex, body mass index (BMI), Epworth Sleepiness Scale score, tonsil size, modified Mallampati (MM) classification, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), lowest oxygen saturation, and VOTE (velum, oropharynx, tongue base, epiglottis) classification were compared between two groups: <60 and ≥60 years old.

Results: Older age had significant correlation with higher AHI, ODI, lower O₂ nadir, multisite obstruction, combined upper (palatopharyngeal) + lower (hypopharyngeal) level obstructions, and complete anterior-posterior (AP) velum collapse pattern. Lateral oropharyngeal wall collapse was significantly lower in the older group. Findings remained statistically significant when adjusted for sex, BMI, tonsil size, and MM.

Conclusions: Aging was an independent factor that directly correlated with increased AHI and hypoxemia, multisites, combined levels of obstruction, and complete AP velum collapse pattern. Being older than 60 years had higher of complete AP velum collapse and lower incidence of lateral oropharyngeal wall collapse, regardless of OSA severity and tonsil size.

Level of evidence: 4 Laryngoscope, 2644-2650, 2018.

Keywords: Age; drug-induced sedation endoscopy; obstructive sleep apnea; sleep endoscopy; upper airway.

Figure 1. Correlation between age and AHI, ODI, LSAT and tonsil size

Age had a significant positive correlation with AHI (Figure 1A, Corr=0.39, P< 0.001 and ODI (Figure 1B, Corr=0.53, P< 0.001), negative correlation with lowest saturation (Figure 1C, Corr=∙0.49, P< 0.001) and tonsil size (Figure 1D, Corr=−0.48, P< 0.001). Statistically significant as P < 0.05.

Figure 2. Obstructive sites and levels in groups

Figure 2A showed that there was no significant difference in single/multiple sites obstruction between groups (P= 0.468). Figure 2B showed combined upper and lower levels obstruction in the ≥ 60 yr. group were significantly higher than < 60 yr. group (P= 0.046). Upper level: obstruction in velum and/or oropharynx (V/O); Lower level: obstruction in tongue base and/or epiglottis (T/E); Combined levels: obstruction in both upper and lower levels (V/O + T/E). Statistically significant as P < 0.05.