Obstructive Sleep Apnea In Older Adults Research Articles

Clinical phenotype of obstructive sleep apnea in older adults: a hospital-based retrospective study in China.

The prevalence of obstructive sleep apnea (OSA) in older people (aged over 65years) is high. However, OSA in older populations has not received sufficient attention. This study examined the clinical phenotypic characteristics of older patients with newly diagnosed OSA. A total of 110 older patients (≥ 65years) and 220 younger patients (< 65years), matched by gender, body mass index (BMI), and apnea-hypopnea index (AHI), were enrolled in this retrospective study. Clinical manifestations, comorbidities, and polysomnographic results were compared between the two groups, and correlations between age ≥ 65years and OSA comorbidities were explored. Nocturia was more common in older patients with OSA, as with lower sleep efficiency, longer wake after sleep onset, increased stage N1 sleep, and decreased stage N3 sleep and average SpO2. The proportions of older OSA patients who had comorbid hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease, and ischemic stroke were significantly higher than those of younger patients. The incidence of tonsillar enlargement and pharyngeal narrowing was lower in older patients. Age ≥ 65years was an independent risk factor for patients with OSA to have hypertension (OR: 1.89, 95% CI: 1.11-3.21), CAD (OR: 4.83, 95% CI: 2.29-10.21), and ischemic stroke (OR: 2.92, 95% CI: 1.02 to 8.38). The presence of OSA in older adults was associated with significant abnormalities of sleep architecture, aggravated nocturnal hypoxia and increased risks of hypertension, CAD, and stroke, which can be distinguished as a unique clinical phenotype.

0727 Age-related association of visceral adiposity with cardiometabolic disorders in mild-to-moderate sleep apnea

Abstract Introduction Visceral adiposity is a key predictor of both metabolic syndrome and obstructive sleep apnea (OSA). Both metabolic syndrome and OSA are associated with cardiometabolic disorders, however, the association of OSA with these disorders weakens in older adults. We compared the relative strength of the association between visceral adiposity vs. OSA with hypertension and diabetes and whether this association is stronger in middle-aged vs. older adults. Methods A clinical sample of 148 adults (53.79±12.45y, 36,5% female) with mild-to-moderate OSA (5≤AHI&amp;lt;30) underwent 8-hour polysomnography, a clinical history and physical examination, including measures of blood pressure and fasting glucose. Hypertension was defined as blood pressure ≥140/90mmHg or use of anti-hypertensive medication. Diabetes was defined as fasting glucose ≥100mg/dL or receiving treatment for diabetes, except insulin. Visceral Adiposity Index (VAI) was calculated within each sex using Amato et al (2010) standardized formulas based on waist, BMI, triglycerides and HDL cholesterol. Logistic regression models examined the association between VAI and AHI with hypertension and diabetes, while simultaneously adjusting for sex and stratifying by age. We also generated under the receiver-operating characteristics (ROC) curves (AUC) having hypertension and diabetes as outcomes and gender, age, BMI, AHI and VAI as independent variables. Results VAI was associated with greater odds of having hypertension (OR=1.57, 95%CI=1.20-2.06, P=0.001) and diabetes (OR=1.27, 95%CI=1.02-1.57, p=0.031) compared to AHI (OR=1.05, 95%CI=0.98-1.13, p=0.185; and OR=1.07, 95% CI=1.00-1.14, p=0.690, respectively) in adults aged &amp;lt;60y. There was no association between VAI or AHI with hypertension and diabetes in adults aged ≥60y. Adding VAI to standard clinical factors (age, sex, and BMI) yielded moderately-good risk models for hypertension (AUC=0.73) and diabetes (AUC=0.70) in adults aged &amp;lt;60y, while suboptimal risk models (AUC=0.61 and 0.68, respectively) in adults aged ≥60y. Conclusion These data indicate that visceral adiposity, but not AHI, is associated with cardiometabolic disorders in patients with mild-to-moderate OSA, an association that is stronger in middle-aged adults. Visceral obesity should be a priority in preventive/therapeutic interventions in young and middle-aged patients with OSA. These findings also further support that OSA in older adults is a distinctly different phenotype. Support (If Any)

0724 Age-related AHI cut-offs associated with cardiovascular and cerebrovascular disorders: clinical implications

Abstract Introduction Several studies have shown that the association of obstructive sleep apnea (OSA) with clinical outcomes, such as hypertension, weakens in older adults. An apnea hypopnea index (AHI) ≥5 is recommended as the cut-off for initiating treatment without any consideration of possible age differences. We aimed to examine at which cut-off point of AHI, OSA is associated with cardiovascular and/or cerebrovascular diseases (CBVD) in middle-aged adults and in older adults. Methods We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority), who underwent a 1-night sleep laboratory evaluation, clinical history and physical examination. Hypertension was defined as a diastolic blood pressure ≥90 mmHg or a systolic blood pressure ≥140 mmHg or the use of anti-hypertensive medication. CBVD was defined based on a self-report of a physician diagnosis of heart disease and/or stroke. Logistic regression models examined the odds of having hypertension or CBVD in a step-wise manner starting from an AHI ≥5 up to AHI ≥30 by increments of 5 events, while simultaneously adjusting for sex, race and BMI and stratifying by age. Results The odds of hypertension were significantly increased in adults aged &amp;lt;60y (43.2±9.1y) with an AHI≥5 (OR=1.56, 95% CI 1.01-2.41, p=0.045), while the odds of hypertension were not significantly increased in adults aged ≥60y (68.4±6.3y) for any given AHI cut-off. The odds of CBVD were significantly increased in adults aged ≥60y with an AHI≥15 (OR=2.50, 95% 1.24-5.04, p=0.011), while the odds of CBVD were not significantly increased in adults aged &amp;lt;60y for any given AHI cut-off. Conclusion These data suggest that AHI cut-offs warranting treatment of OSA should be adjusted based on age and prevalent clinical disorders, consistent with the concept of personalized medicine. These findings are also consistent with the notion that OSA in older adults is a distinctly different phenotype than in young and middle-aged adults. Support (If Any)

Associations of the Severity of Obstructive Sleep Apnea With Age-Related Comorbidities: A Population-Based Study.

Aging is accompanied by changes in the quantity and quality of sleep. Obstructive sleep apnea (OSA) is also more prevalent in the older population. Although severe OSA has been linked to a higher risk of cardiovascular disease regardless of adult age, clinical consequences of mild-to-moderate OSA in the older adults are still uncertain.ObjectivesTo investigate the relationships between severity and metabolic, cognitive, and functional characteristics in community-dwelling older adults from a representative sample of the city of São Paulo.MethodsIn total, 199 participants of the first follow-up of the São Paulo Epidemiologic Sleep Study (EPISONO, São Paulo, Brazil) >60 years were cross-sectionally assessed through questionnaires, physical evaluations, laboratory tests, and full in-lab polysomnography (PSG). Three groups according to the OSA severity were compared according to sociodemographic characteristics, anthropometric measures, PSG parameters, the frequency of comorbidities, and the use of medications.ResultsParticipants' age ranged from 60 to 87 years with a mean of 70.02 ± 7.31, 59.8% female. In the univariate analysis, body mass index (BMI, kg/m2) (p = 0.049) and waist circumference (p = 0.005) were significantly higher in the participants with moderate OSA, but not among those with severe OSA. Participants with severe OSA had a higher arousal index (p = 0.007). Multivariate analysis showed that severe OSA was significantly associated with hypertension (p = 0.005), heart diseases (p = 0.025), and the use of two or more medications (p = 0.035).ConclusionIn a population-based study, severe, but not mild-to-moderate, OSA in older adults was associated with hypertension and the use of more medications. As age advances, anthropometric indicators of obesity may not increase the risk of severe OSA.

Apnea in Elderly

Obstructive sleep apnea (OSA) is common in older adults. However, there is controversy regarding the diagnosis, consequences, and treatment of OSA in this patient population. This review presents the current evidence pertaining to the pathogenesis, diagnosis, complications, and management of OSA in older adults. OSA is prevalent and underdiagnosed in the elderly. A growing body of evidence demonstrates that moderate to severe OSA in older adults is linked to neurocognitive decline and chronic vascular disease, including increased risk of incident heart failure and ischemic stroke. Positive airway pressure therapy remains the mainstay of treatment. Systematic investigations are needed to validate screening tools and diagnostic methods for OSA in elderly and to delineate the subpopulation of elderly in whom therapy is warranted. Targeted approach to diagnosis and treatment needs to be undertaken to avoid the deleterious consequences of sleep apnea in this vulnerable population.

Gout and the Risk of Incident Obstructive Sleep Apnea in Adults 65 Years or Older: An Observational Study.

To assess whether gout is associated with a higher risk of obstructive sleep apnea (OSA) in older adults. We used the 5% United States Medicare beneficiary sample from 2006-2012 to assess whether gout was independently associated with new diagnosis of OSA in adults 65 years or older, adjusting for demographics, medical comorbidity (Charlson-Romano index) and hypertension, hyperlipidemia and coronary artery disease, and the use of medications for cardiovascular diseases or gout (allopurinol, febuxostat). Based on 10,448,472 person-years of follow-up in a cohort of 1.74 million adults 65 years or older, the crude incidence rates of OSA were 14.3 per 1,000 person-years in people with gout and 3.9 per 1,000 person-years in people without gout. In multivariable-adjusted analyses, gout was associated with higher risk of a new diagnosis of OSA during the follow-up, hazard ratio was 2.07 (95% confidence interval [CI] 2.00, 2.15). In sensitivity analyses that substituted continuous Charlson-Romano score with a categorical variable or individual Charlson-Romano comorbidities plus hypertension, hyperlipidemia and coronary artery disease, the main finding was confirmed, hazard ratios were 2.11 (95% CI 2.03, 2.18) and 1.79 (95% CI 1.73, 1.85). The independent association of gout with a twofold higher risk of OSA in older adults indicates that common mechanisms may be shared by the two conditions. More studies are needed to investigate these mechanisms further.

The Association Between Obstructive Sleep Apnea and Depression in Older Adults.

BackgroundDepression is the most frequent psychiatric disorder among the elderly. Obstructive sleep apnea (OSA) is a chronic and prevalent disease that has an ambiguous role in triggering depression. Several researches with contradictory findings have been performed about the association between OSA and depression.ObjectivesThis study aimed to investigate the association between OSA and depression among elderly.Patients and MethodsA total of 350 home residing elderly took part in this case-control study. The participants were selected using clustering method. All cases were divided into two groups of depressed and non-depressed using the geriatric depression scale (GDS). Then they were matched in age, gender, education and body mass index (BMI). Berlin questionnaire (BQ) was used to diagnose OSA. Data analysis was performed using Mann-Whitney U test, t-test, Chi-square and Fisher’s exact tests and odds ratio.ResultsTotally, 60.6 % of depressed group and 18.9 % of non-depressed group were in high risk for OSA. A significant association was found between OSA and depression (P < 0.001, OR = 6.61, CI 95 % = 4.1 - 10.7). In addition, a significant association was found between gender and OSA (P = 0.008).ConclusionsOSA was associated with depression among the elderly patients. Given the high prevalence of OSA in older adults, implementation of screening methods is necessary to identify people at high risk of OSA.

The Different Clinical Faces of Obstructive Sleep Apnea (OSA), OSA in Older Adults as a Distinctly Different Physiological Phenotype, and the Impact of OSA on Cardiovascular Events after Coronary Artery Bypass Surgery.

Failure to appreciate the heterogeneity of obstructive sleep apnea (OSA) may impede its clinical recognition and management (1, 2). Using cluster analysis from a large, cross-sectional, clinically based cohort of adults with moderate-to-severe OSA, representative of the population of Iceland, Ye and colleagues identified subgroups with distinct combinations of symptoms (1). Included in the analysis were 822 subjects who were positive airway pressure naive. These were predominantly middle-aged obese males with severe OSA. Three distinct clusters were identified: (1) a “disturbed sleep” cluster (33%) with the highest probability of experiencing insomnia-related symptoms such as difficulty with sleep initiation and maintenance, nocturnal and early awakenings, nocturnal sweating, restless sleep, restless leg symptoms, and symptom of gasping for breath; (2) a “minimally symptomatic” cluster (25%) with the highest probability of feeling rested on awaking; and (3) an “excessive daytime sleepiness” cluster (42%) with a higher probability of daytime hypersomnolence (as measured by the Epworth Sleepiness Scale), the presence of daytime sleepiness-related symptoms (such as falling asleep unintentionally during the day, dozing off while driving), and symptoms of witnessed apneas and loud snoring. The identification of the “disturbed sleep” group in this study, underscores the presence of OSA in those with comorbid insomnia, suggesting that both the screening for OSA in those with insomnia as well as treatment with combination therapies (e.g., positive airway pressure and cognitive behavioral therapy for insomnia) may be beneficial in this population (3). Furthermore, the probabilities of having comorbid hypertension and cardiovascular disease were highest in the “minimally symptomatic” but lowest in the “excessive daytime sleepiness” group. The authors proposed that a potentially longer lag time between initial symptoms and diagnosis in minimally symptomatic compared with symptomatic patients may lead to a longer duration of exposure to untreated OSA and, thus, a higher probability of developing comorbidities. However, the crosssectional design of this study makes it impossible to infer causality, and as with any observational study, there are limitations related to unmeasured confounders such as depression or cognitive impairment. In addition, the study results are pertinent to the specific patient group evaluated, and extrapolation to other OSA cohorts may be inapplicable. Despite no statistical or clinically meaningful difference observed in sex, age, body mass index, apnea–hypopnea index, oxygen desaturation index, or minimal oxygen saturation among the three clusters, these important variables may account for different clinical presentations of OSA. Lastly, the use of type 3 portable monitors may have contributed to the underestimation of the apnea–hypopnea index in those with insomnia. As such, further validation in independent cohorts including a broader demographic profile and OSA severity is needed. Regardless of limitations, this study serves to highlight and increase physician awareness of the heterogeneity of OSA clinical presentation. It also provides clinicians with some guidance as to the differing OSA phenotypic presentations. In so doing it may facilitate early identification of OSA and lead to the development of personalized therapies. This may be of particular importance in those who are less symptomatic or who experience less common symptoms of OSA, although the need for treatment of minimally symptomatic patients remains uncertain at this time (4, 5). n

Serotonin transporter polymorphism is associated with increased apnea-hypopnea index in older adults.

A functional polymorphism of the serotonin transporter gene (5-HTTLPR) has previously been related to upper airway pathology, but its contribution to obstructive sleep apnea (OSA), a highly prevalent sleep disorder in older adults, remains unclear. We aimed to investigate the relationship between apnea-hypopnea index (AHI) and genetic variations in the promoter region of the 5-HTTLPR in older adults. DNA samples from 94 community-dwelling older adults (57% female, mean age 72 ± 8) were genotyped for the 5-HTTLPR polymorphism. All participants were assessed in their homes with full ambulatory polysomnography in order to determine AHI and related parameters such as hypoxia, sleep fragmentation, and self-reported daytime sleepiness. The 5-HTT l allele was significantly associated with AHI (p = 0.019), with l allele carriers displaying a higher AHI than s allele homozygotes. A single allele change in 5-HTTLPR genotype from s to l resulted in an increase of AHI by 4.46 per hour of sleep (95% CI, 0.75-8.17). The l allele was also associated with increased time during sleep spent at oxygen saturation levels below 90% (p = 0.014). The observed significant association between the 5-HTTLPR l allele and severity of OSA in older adults suggests that the l allele may be important to consider when assessing for OSA in this age group. This association may also explain some of the observed variability among serotonergic pharmacological treatment studies for OSA, and 5-HTT genotype status may have to be taken into account in future therapeutic trials involving serotonergic agents.