Altersgebrechlichkeit und Schlafapnoe

  • H. Frohnhofen
  • B. Nickel
  • B. Talbi
  • H.C. Heuer
  • P. Wilschrei
  • C. Falkenhahn
Schwerpunkt

Zusammenfassung

Einleitung

Altersgebrechlichkeit („frailty“) und Schlafapnoe sind häufige Entitäten im hohen Lebensalter. Altersgebrechlichkeit führt zu Abhängigkeit und Pflegebedürftigkeit. Die Verhinderung von Altersgebrechlichkeit ist eine der wichtigsten geriatrischen Aufgaben. Der Zusammenhang zwischen Schlafapnoe und Altersgebrechlichkeit ist kaum untersucht.

Methodik

In einer prospektiven Pilotstudie untersuchten wir die Beziehung zwischen dem Vorhandensein wenigstens eines der 5 “frailty symptoms“ nach Fried und einer Schlafapnoe bei geriatrischen Klinikpatienten mit erhaltener Kommunikationsfähigkeit und ohne Demenz. Als Surrogatkriterium für eine Schlafapnoe diente die nächtliche Pulsoxymetrie. Tagesmüdigkeit wurde mittels Fragebogen nach Siegrist erfasst.

Ergebnisse

In die Studie wurden 42 Patienten mit einem mittleren Alter von 82 ± 7 Jahren eingeschlossen, 15 m (36%), 27 w (64%). Bei 28 Patienten (67%) lag wenigstens ein Frailty-Symptom vor. Patienten mit Frailty-Kriterien gaben signifikant häufiger Tagesmüdigkeit an (1/14 vs. 17/28, p < 0,001) und wiesen signifikant häufiger eine schwere Schlafapnoe mit einem Entsättigungsindex > 30/h (p <0,04) und eine niedrigere durchschnittliche nächtlich Sauerstoffsättigung (95 ± 2 vs. 91 ± 4%; p <0,02) auf.

Schlussfolgerung

Unsere Pilotstudie zeigt an einem kleinen Kollektiv geriatrischen Klinikpatienten eine Assoziation zwischen dem Vorliegen wenigstens eines Frailty-Kriteriums, Tagesschläfrigkeit und Schlafapnoe. Angesichts der Häufigkeit beider Phänomene und der klinischen Relevanz von Altersgebrechlichkeit sind prospektive Studien zum Nachweis einer kausalen Beziehung zwischen Altersgebrechlichkeit und Schlafapnoe gerechtfertigt.

Schlüsselwörter

Altersgebrechlichkeit Müdigkeit Schlafapnoe Hohes Alter Schlafstörung 

Frailty and sleep apnea

Abstract

Background

Frailty and sleep apnea are common entities in the elderly. Frailty causes dependency and need of care. The prevention of frailty is a major topic in geriatrics. However, the relationship between sleep apnea and frailty has hardly been studied.

Methods

In a prospective pilot study, the relationship between the presence of at least one of the five frailty criteria proposed by Fried and sleep apnea were examined. Patients were eligible, if they able to communicate and had no dementia. Sleep apnea was diagnosed by overnight pulse oximetry. Tiredness was obtained using the questionnaire by Siegrist.

Results

A total of 42 patients with a mean age of 82 ± 7 years were enrolled. There were 15 (36%) male and and 27 (64%) female patients, of which 28 (67%) patients met at least one frailty criterion. Patients with frailty criteria experienced significantly more often daytime sleepiness (1/14 vs. 17/28, p <0.001), had a significantly higher incidence of severe sleep apnea with an oxygen desaturation index > 30/h (p <0.04) and had a lower mean nocturnal oxygen saturation (95 ± 2% vs. 91 ± 4%, p <0.02).

Conclusion

Our small pilot study showed an association between the presence of at least one frailty criterion, daytime sleepiness, and severe sleep apnea. Given the high frequency of both phenomena and regarding the clinical relevance of frailty, prospective studies are warranted to prove a causal relationship between sleep apnea and frailty.

Keywords

Frail elderly Tiredness Sleep apnea Aged Dyssomnia 

Literatur

  1. 1.
    Ancoli-Israel S, Kripke DF, Klauber MR et al (1991) Sleep-disordered breathing in community-dwelling elderly. Sleep 14:486–495PubMedGoogle Scholar
  2. 2.
    Ancoli-Israel S (2005) Sleep and aging: prevalence of disturbed sleep and treatment considerations in older adults. J Clin Psychiatry 66(Suppl 9):24–30PubMedGoogle Scholar
  3. 3.
    Bergmann H, Ferruci L, Guralnik J et al (2007) Frailty: An emerging research and clinical paradigm – issues and controversies. J Gerontol A Biol Sci Med Sci 62A:731–737Google Scholar
  4. 4.
    Bliwise DL, Colrain IM, Swan GE, Bliwise NG (2010) Incident sleep disordered breathing in old age. J Gerontol A Biol Sci Med Sci 65A:997–1003CrossRefGoogle Scholar
  5. 5.
    Bortz WM (2002) A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci 57:M283–M288PubMedCrossRefGoogle Scholar
  6. 6.
    Cluydts R, De Valck E, Verstraeten E, Theys P (2002) Daytime sleepiness and its evaluation. Sleep Med Rev 6:83–96PubMedCrossRefGoogle Scholar
  7. 7.
    Cochen V, Arbus C, Soto ME et al (2009) Sleep disorders and their impacts on health, dependent, and frail older adults. J Nutr Health Aging 13:322–329PubMedCrossRefGoogle Scholar
  8. 8.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis. Age Ageing 39:412–423PubMedCrossRefGoogle Scholar
  9. 9.
    Dam TT, Ewing S, Ancoli-Israel S (2008) Association between sleep and physical function in older men. The osteoporosis fractures in men sleep study. J Am Geriatr Soc 56:1665–1673PubMedCrossRefGoogle Scholar
  10. 10.
    Drey M, Pfeifer K, Sieber CC, Bauer JM (2011) The Fried frailty criteria as inclusion criteria for a randomized controlled trial: personal experience and literature review. Gerontology 57:11–18PubMedCrossRefGoogle Scholar
  11. 11.
    Drey M, Wehr H, Wehr G et al (2011) The frailty syndrome in general practitioner care. Z Gerontol Geriatr 44:48–54PubMedCrossRefGoogle Scholar
  12. 12.
    Endeshaw YW, Unruh ML, Kutner M, Newman AB, Bliwise DL (2009) Sleep-related breathing and frailty in the cardiovascular health study cohort. Am J Epidemiol 170:193–202PubMedCrossRefGoogle Scholar
  13. 13.
    Ensrud KE, Blackwell TL, Redline S et al (2009) Osteoporotic fractures in men study group. Sleep disordered breathing and frailty status in older community-dwelling men. J Am Geriatr Soc 57:2085–2093PubMedCrossRefGoogle Scholar
  14. 14.
    Ferrucci L, Guralnik JM, StudenskiS, Fried LP, Cutler GB, Waltson JD (Interventions on Frailty Working Group) (2004) Designing randomized, controlled trails aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 52:625–634PubMedCrossRefGoogle Scholar
  15. 15.
    Fisher AL (2005) Just what defines frailty? J Am Geriatr Soc 53:2229–2230PubMedCrossRefGoogle Scholar
  16. 16.
    Folstein MF, Folstein SE, McHugh PR (1975) Mini Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRefGoogle Scholar
  17. 17.
    Fried LP, Tangen CM, Waltson J (2001) Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56A:M146–M156CrossRefGoogle Scholar
  18. 18.
    Frohnhofen H, Hoeltmann B, Orth G (2009) Acceptance of NCPAP in a sample of patients admitted for geriatric rehabilitation. Eur J Med Res 14(Suppl 4):82–85PubMedGoogle Scholar
  19. 19.
    Frohnhofen H, Popp R, Willmann V, Heuer HC, Firat A (2009) Feasibility of the Epworth Sleepiness Scale in a sample of geriatric in-hospital patients. J Physiol Pharmacol 60(Suppl 5):45–49PubMedGoogle Scholar
  20. 20.
    Gillick M (1995) Choosing medical care in old age. Harvard University Press, New YorkGoogle Scholar
  21. 21.
    Goldman ES, Ancoli-Israel S, Boudreau R eet al (2008) Sleep problems and associated daytime fatigue in community-dwelling older individuals. J Gerontol A Biol Sci Med Sci 63:1069–1075PubMedGoogle Scholar
  22. 22.
    Goldman SE, Ancoli-Israel S, Boudreau R et al (2008) Health, aging and body composition study. J Gerontol A Biol Sci Med Sci 63:1069–1075PubMedGoogle Scholar
  23. 23.
    Gross CP, Anderson GF, Powe NR (1999) The relation between funding by the National Institutes of Health and the burden of disease. N Engl J Med 340:1881–1887PubMedCrossRefGoogle Scholar
  24. 24.
    Hastings SN, Purser JL, Johnson KS, Sloane RJ, Whitson HE (2008) Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. J Am Geriatr Soc 56:1651–1657PubMedCrossRefGoogle Scholar
  25. 25.
    Judge JO, Schecktman K, Cress E (The FICSIT Group) (1996) The relationship between physical performance measures and independence in instrumental activities of daily living. J Am Geriatr Soc 44:1332–1341PubMedGoogle Scholar
  26. 26.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186PubMedCrossRefGoogle Scholar
  27. 27.
    Mahony FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65Google Scholar
  28. 28.
    Purser JL, Kuchibhatla MN, Fillenbaum GG et al. (2006) Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc 54:1674–1681PubMedCrossRefGoogle Scholar
  29. 29.
    Rockwood K, Andrew M, Mitnitski A (2007) Unconventional views of frailty: a comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 62:738–743PubMedGoogle Scholar
  30. 30.
    Siegrist J, Peter J, Himmelmann J, Geyer S (1987) Experiences with an anamnesis questionnaire in the diagnosis of sleep apnea. Prax Klin Pneumol 41:357–363PubMedGoogle Scholar
  31. 31.
    Van Cauter E, Plat L, Copinschi G (1998) Interrelations between sleep and the somatotropic axis. Sleep 21:553–566Google Scholar
  32. 32.
    Vaz Fragoso CA, Gahbauer E, Van Ness PH, Gill TM (2009) Sleep-wake disturbances and frailty in community-living older persons. J Am J Geriatr Soc 57:2094–2100CrossRefGoogle Scholar
  33. 33.
    Whinston HE, Purser JL, Cohen HJ (2007) Unconventional views of frailty. J Gerontol A Biol Sci Med Sci 62A:728–730Google Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • H. Frohnhofen
    • 1
    • 2
  • B. Nickel
    • 1
  • B. Talbi
    • 1
  • H.C. Heuer
    • 1
  • P. Wilschrei
    • 1
  • C. Falkenhahn
    • 1
  1. 1.Zentrum für AltersmedizinKliniken Essen-MitteEssenDeutschland
  2. 2.Fakultät für Gesundheit, Department HumanmedizinUniversität Witten-HerdeckeWitten-HerdeckeDeutschland

Personalised recommendations