Can aging increase upper-airway collapsibility and raise obstructive sleep apnea risk?

Age-related changes in airway control and structure provide a physiologically coherent explanation for greater obstructive sleep apnea (OSA) susceptibility in later life. This is particularly relevant at age 83, although the available data in very old adults are limited.

Clinical and physiological evidence

• Older age is an established OSA risk factor; adults aged 60–79 have been reported to be approximately three times more likely to have OSA.
• In patients with OSA, upper-airway collapsibility was greater in older than younger adults: mean critical closing pressure (Pcrit) was about 0.8 ± 0.8 cmH₂O versus −1.0 ± 1.5 cmH₂O. A higher Pcrit indicates that the pharynx closes more readily during sleep.
• Airway collapsibility is a central physiological determinant of obstructive events and appears to be a relatively stronger contributor to OSA vulnerability in older than younger adults.

Mechanistic explanation

• Aging can impair compensatory recruitment of pharyngeal dilator muscles, especially the genioglossus. In men, genioglossus response to negative airway pressure declined with age (r = −0.59; P = .008).
• The most supported neuromuscular effect is reduced protective reflex responsiveness and greater sleep-related loss of phasic muscle activation, rather than a universal reduction in baseline muscle strength.
• Age-associated anatomy—including greater parapharyngeal fat, longer soft palate/pharyngeal airway dimensions, and altered pharyngeal skeletal geometry—can increase resistance and promote collapse under inspiratory negative pressure. These anatomical and neuromuscular factors can act together.

Clinical implications

• Bottom line: The claim is supported: aging can make the upper airway more collapsible through impaired dilator-muscle compensation and structural airway changes, thereby increasing susceptibility to OSA. The physiological link between collapsibility and OSA is strong; the precise independent contribution of each age-related pathway is moderately certain.