• Azadeh Yadollahi, Joseph M Gabriel, Laura H White, Luigi Taranto Montemurro, Takatoshi Kasai, and T Douglas Bradley.
• Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
• Sleep. 2014 Oct 1;37(10):1699-705.

Study ObjectivesObstructive sleep apnea (OSA) is commoner in patients with fluid-retaining states than in those without fluid retention, in men than in women, and worsens with aging. In men, OSA severity is related to the amount of fluid shifting out of the legs overnight, but a cause-effect relationship is not established. Our objective was to test the hypothesis that mimicking fluid overload during sleep would increase severity of OSA more in older (≥ 40 years) than in younger men (< 40 years).DesignRandomized, single-blind, double crossover study.SettingResearch sleep laboratory.Patients Or ParticipantsSeven older and 10 younger men with non-severe or no sleep apnea, matched for body mass index.InterventionsDuring the control arm, normal saline was infused to keep the vein open. During intervention, subjects received an intravenous bolus of normal saline (22 mL/kg body weight) after sleep onset while they were wearing compression stockings to prevent fluid accumulation in the legs.Measurements And ResultsCompared to younger men, infusion of similar amounts of saline in older men caused a greater increase in neck circumference (P < 0.05) and in the AHI (32.2 ± 22.1 vs. 2.2 ± 7.1, P = 0.002).ConclusionsOlder men are more susceptible to the adverse effects of intravenous fluid loading on obstructive sleep apnea severity than younger men. This may be due to age-related differences in the amount of fluid accumulating in the neck or upper airway collapsibility in response to intravenous fluid loading. These possibilities remain to be tested in future studies.© 2014 Associated Professional Sleep Societies, LLC.

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