Narrow upper airway may contribute to sleep apnea

By Emma Hitt, PhD

NEW YORK (Reuters Health) – Although snoring is often linked to obesity, new study findings suggest that a narrow upper airway may also cause obstructive sleep apnea (OSA).

According to Dr. John R. Stradling and colleagues from Oxford University, UK, the most common reason for a narrowing of the throat during sleep, a cause of OSA, is enlarged tonsils and adenoids. So the researchers wanted to see whether children who had had their tonsils and adenoids removed experienced OSA 12 years later.

"Enlarged tonsils occupy a significant space in the throat and narrow the airway," Dr. Stradling told Reuters Health. "With the normal narrowing that occurs with sleep, the space gets critically small."

Dr. Stradling and colleagues evaluated the nighttime breathing of 20 teenagers who had had their tonsils and adenoids removed 12 years earlier when they were about 4 years old. The children had all been snorers and had had repeated bouts of enlarged tonsils before surgery.

The investigators compared the nighttime breathing of these teens with that of 20 healthy teens for whom breathing data were also collected 12 years earlier.

Writing in the January issue of the Archives of Disease in Childhood, the researchers report that many of the teens who had had their tonsils removed showed signs of sleep apnea, suggesting that they may have a narrow throat persisting into adulthood.

The nasal blockage and adenoidal swelling experienced by the teens during childhood might, by causing them to breathe through their mouths, "lead to the very changes in lower facial shape…that are thought to contribute to airway crowding," the authors note.

Helping these children to breathe through their noses rather than their mouths could prevent these facial changes from occurring, they add.

"These findings are one further piece of evidence that a predisposition to snoring and OSA in both children and adults may result from the common risk factor of a small upper airway," Dr. Stradling's team concludes.

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