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VOLUME 31, ISSUE 04


Puberty and Upper Airway Dynamics During Sleep

Preetam Bandla, MD1; Jingtao Huang, PhD1; Laurie Karamessinis, RPFT1; Andrea Kelly, MD2; Michelle Pepe, RPSGT1; John Samuel, RPSGT1; Lee Brooks, MD1; Thornton. A. Mason II, MD, PhD1; Paul R. Gallagher, MA3; Carole L. Marcus, MBBCh1

1Sleep Center, 2Division of Endocrinology, and 3Division of Biostatistics and Epidemiology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA



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Study Objectives:

The upper airway compensatory response to subatmospheric pressure loading declines with age. The epidemiology of obstructive sleep apnea suggests that sex hormones play a role in modulating upper airway function. Sex hormones increase gradually during puberty, from minimally detectable to adult levels. We hypothesized that the upper airway response to subatmospheric pressure loading decreased with increasing pubertal Tanner stage in males but remained stable during puberty in females.

Design:

Upper airway dynamic function during sleep was measured over the course of puberty.

Participants:

Normal subjects of Tanner stages 1 to 5.

Measurements:

During sleep, maximal inspiratory airflow was measured while varying the level of nasal pressure. The slope of the upstream pressure-flow relationship (SPF) was measured.

Results:

The SPF correlated with age and Tanner stage. However, the relationship with Tanner stage became nonsignificant when the correlation due to the mutual association with age was removed. Females had a lower SPF than males.

Conclusions:

In both sexes, the upper airway compensatory response to subatmospheric pressure loading decreased with age rather than degree of pubertal development. Thus, changes in sex hormones are unlikely to be a primary modulator of upper airway function during the transition from childhood to adulthood. Although further studies of upper airway structural changes during puberty are needed, we speculate that the changes in upper airway function with age are due to the depressant effect of age on ventilatory drive, leading to a decrease in upper airway neuromotor tone.
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