Assessing the risk of obstructive sleep apnoea-hypopnoea syndrome in elderly home care patients with chronic multimorbidity: a cross-sectional screening study.

Christos F Kleisiaris,Zoe Daniil,George Markakis,Ioanna V Papathanasiou,Zacharenia Androulaki,Konstantinos I Gourgoulianis,Evangelos I Kritsotakis

doi:10.1186/s40064-016-1672-0

Abstract

Obstructive sleep apnoea–hypopnea syndrome (OSAHS) and multimorbidity are common in elderly patients, but a potential link between the two conditions remains unclear. This study aimed to assess the prevalence of OSAHS, chronic multimorbidity and their relation in older adults in primary care settings. A screening study was performed in a cross-section of 490 elderly adults (mean age 77.5 years, 51 % male) receiving home care services in Thessaly, central Greece. The Berlin Questionnaire was employed to assess the likelihood for OSAHS and the Epworth Sleepiness Scale to assess daytime sleepiness. Multimorbidity was defined as a documented history of at least two chronic diseases. The prevalence of high risk for OSAHS, excessive daytime sleepiness and multimorbidity was 33.5, 11.6 and 63.9 %, respectively. None of the study subjects had a confirmed diagnosis for OSAHS prior to this study. A marked dose–response association between a high pre-test likelihood for OSAHS and multimorbidity was noted in patients with two [adjusted odds ratio (OR) 3.13; 95 % confidence interval (CI) 1.85–5.30) and three or more (adjusted OR 4.22; 95 % CI 2.55–6.96) chronic morbidities, independently of age, sex and smoking status. This association persisted across different levels for OSAHS risk in the Berlin questionnaire, was insensitive to varying definitions of multimorbidity and more pronounced in patients with excessive daytime sleepiness. These findings point out that primary care physicians who care for elderly patients who present with several, common and burdensome, chronic diseases should expect to find this multimorbidity often coinciding with undetected, and therefore untreated, OSAHS. Thus it is crucial to consider OSAHS as an important co-morbidity in older adults and systematically screen for OSAHS in primary care practice.

Highlights

Obstructive sleep apnoea–hypopnoea syndrome (OSAHS) is a common disorder that affects least 2–4 % of the adult population (Young et al 1993; Epstein et al 2009)
Evidence of an association between OSAHS and multimorbidity could serve as a crucial incentive for the systematic screening for OSAHS in primary care settings (Robichaud-Hallé et al 2012)
We examined the persistence of this association in the subgroup of subjects who presented with excessive daytime sleepiness and its sensitivity to varying definitions of multimorbidity

Summary

Introduction

Obstructive sleep apnoea–hypopnoea syndrome (OSAHS) is a common disorder that affects least 2–4 % of the adult population (Young et al 1993; Epstein et al 2009). OSAHS and chronic diseases are both commonly seen in primary care settings and their frequency varies widely with age and gender (Karachaliou et al 2007; Minas et al 2010; Kleisiaris et al 2014). A potential link between OSAHS and multimorbidity has not been studied extensively (Robichaud-Hallé et al 2012), mainly because the syndrome often remains undiagnosed in primary care practice (Young et al 1993; Karachaliou et al 2007). Evidence of an association between OSAHS and multimorbidity could serve as a crucial incentive for the systematic screening for OSAHS in primary care settings (Robichaud-Hallé et al 2012)

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Discussion

Conclusion