Sleep disordered breathing in the geriatric patient population

Abstract

Abstract Sleep disordered breathing (SDB) is a spectrum of nocturnal breathing events. It consists of obstructive, central, and mixed sleep apnea as well as upper airway resistance syndrome and snoring. Obstructive sleep apnea is characterized by repetitive upper airway obstructive events. The primary symptoms include excessive daytime sleepiness, snoring, and impairment of cognition. In some cases, it can be associated with increased risk of motor vehicle accidents. Obstructive sleep apnea (OSA) varies considerably in its distribution in age and its severity. The exact mechanism of OSA is not yet fully delineated but multiple factors are generally associated with the development of the sleep apnea (SA) syndrome. These factors include upper airway anatomic obstruction, as well as mechanical, neurological, and possibly inflammatory changes in the pharyngeal airspace. The prevalence of the OSA increases with aging. Most studies report a prevalence rate ranging between 11 and 62%. It is further associated with increased mortality in the older patient population. Central sleep apnea (CSA) occurs in higher frequency among patients with cerebral vascular accidents, central nervous system (CNS) tumors, CNS infections, encephalopathies, and congestive heart failure. Patients with cerebral vascular accidents have a markedly elevated prevalence of sleep apnea mainly in the form of OSA and also have a poorer prognosis after an acute infarct. Patients with Alzheimer’s disease also have more frequent SDcB. This SDB should certainly be considered in the differential diagnosis of reversible dementia as treatment of the underlying SDB improves cognitive dysfunction. Medical management of SA relies on treatment with positive pressure therapy and rarely with use of medications, or with surgery. The role of oral appliances has not been clearly determined in elderly cohorts. The aim of this chapter is to help shed light on the epidemiology, pathophysiology, diagnosis, and management of SDB in the geriatric patient population.