Identifying obstructive sleep apnea in geriatric outpatients with neuropsychological testing

Abstract

AbstractBackgroundObstructive sleep apnea (OSA) is common in geriatric patients and has been associated with neurocognitive disorders such as Alzheimer’s disease and other dementias. Dexter and Ebert (2019) reported a unique pattern of lower scores for immediate memory relative to delayed memory was observed in patients with OSA on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The aim of the current investigation was to examine the frequency of confirmed OSA diagnosis in persons with snoring and immediate memory scores less than delayed memory scores in ambulatory geriatric patients referred for memory assessment.MethodPatients were initially assessed for memory complaints at the University of Wisconsin‐Madison Geriatric Memory Assessment Clinic (2016 ‐2020). All patients completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, Randolph, 1998, 2012) as part of a multidisciplinary evaluation. Patients were referred for a sleep evaluation if sleep disordered breathing was reported and the score difference was noted with immediate memory being less than delayed memory on RBANS. Sleep evaluations consisted of either home sleep testing or polysomnography, based on clinical indication. Board‐certified sleep medicine physicians interpreted all sleep studies, and graded the severity of OSA as mild, moderate, or severe.ResultResults are depicted in Table 1. There were 251 patients referred for sleep evaluation (mean age 75.5 years). Of these, 158 patients completed sleep testing (93 males; 65 females), of which 127 (80.4%) were ultimately diagnosed with OSA. Among sleep study completers, 72 (57%) had moderate or worse sleep apnea. The proportion of cases with moderate or worse sleep apnea was similar for male (59%) and female (53%) completers.ConclusionThis retrospective investigation involved geriatric memory clinic patients with RBANS scores that were lower in immediate memory compared to delayed memory and evidence of snoring that resulted in a referral for a sleep study. The finding of OSA in 80% of the patients evaluated, and the comparable results of male and female patients suggests that all patients who snore and have this unique RBANS profile should be assessed for OSA.