Advertisement

Current Sleep Medicine Reports

, Volume 5, Issue 1, pp 13–22 | Cite as

Apnea in Elderly

  • Salam ZeineddineEmail author
  • Susmita Chowdhuri
Sleep and Sleep Apnea at the Extremes (D Gozal, Section Editor)
  • 6 Downloads
Part of the following topical collections:
  1. Topical Collection on Sleep and Sleep Apnea at the Extremes

Abstract

Purpose of Review

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.

Recent Findings

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.

Summary

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.

Keywords

Sleep-disordered breathing Obstructive sleep apnea Elderly CPAP 

Notes

Compliance with Ethical Standards

Conflict of Interest

Salam Zeineddine and Susmita Chowdhuri each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Rodriguez JC, Dzierzewski JM, Alessi CA. Sleep problems in the elderly. Med Clin North Am. 2015;99(2):431–9.Google Scholar
  2. 2.
    Miner B, Kryger MH. Sleep in the aging population. Sleep Med Clin. 2017;12(1):31–8.Google Scholar
  3. 3.
    Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge. Psychogeriatrics. 2018;18(3):155–65.Google Scholar
  4. 4.
    Bruce EN, Bruce MC, Vennelaganti S. Sample entropy tracks changes in electroencephalogram power spectrum with sleep state and aging. J Clin Neurophysiol. 2009;26(4):257–66.Google Scholar
  5. 5.
    Mattis J, Sehgal A. Circadian rhythms, sleep, and disorders of aging. Trends Endocrinol Metab. 2016;27(4):192–203.Google Scholar
  6. 6.
    Vitiello MV, Moe KE, Prinz PN. Sleep complaints cosegregate with illness in older adults: clinical research informed by and informing epidemiological studies of sleep. J Psychosom Res. 2002;53(1):555–9.Google Scholar
  7. 7.
    Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–32.Google Scholar
  8. 8.
    Suzuki K, Miyamoto M, Hirata K. Neurological common diseases in the super-elder society. Topics: V. Dizziness, faintness, numbness and insomnia: 3. Characteristics and treatment of sleep disorders in the elderly. Nihon Naika Gakkai Zasshi. 2014;103(8):1885–95.Google Scholar
  9. 9.
    Endeshaw Y. Clinical characteristics of obstructive sleep apnea in community-dwelling older adults. J Am Geriatr Soc. 2006;54(11):1740–4.Google Scholar
  10. 10.
    Braley TJ, Dunietz GL, Chervin RD, Lisabeth LD, Skolarus LE, Burke JF. Recognition and diagnosis of obstructive sleep apnea in older Americans. J Am Geriatr Soc. 2018;66(7):1296–302.Google Scholar
  11. 11.
    Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the sleep heart health study. Arch Intern Med. 2002;162(8):893–900.Google Scholar
  12. 12.
    Lindberg E, Taube A, Janson C, Gislason T, Svardsudd K, Boman G. A 10-year follow-up of snoring in men. Chest. 1998;114(4):1048–55.Google Scholar
  13. 13.
    Enright PL, Newman AB, Wahl PW, Manolio TA, Haponik EF, Boyle PJ. Prevalence and correlates of snoring and observed apneas in 5,201 older adults. Sleep. 1996;19(7):531–8.Google Scholar
  14. 14.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.Google Scholar
  15. 15.
    Mehra R, Stone KL, Blackwell T, Ancoli Israel S, Dam TT, Stefanick ML, et al. Prevalence and correlates of sleep-disordered breathing in older men: osteoporotic fractures in men sleep study. J Am Geriatr Soc. 2007;55(9):1356–64.Google Scholar
  16. 16.
    Morales CR, Hurley S, Wick LC, Staley B, Pack FM, Gooneratne NS, et al. In-home, self-assembled sleep studies are useful in diagnosing sleep apnea in the elderly. Sleep. 2012;35(11):1491–501.Google Scholar
  17. 17.
    Nguyen-Michel VH, Levy PP, Pallanca O, Kinugawa K, Banica-Wolters R, Sebban C, et al. Underperception of naps in older adults referred for a sleep assessment: an insomnia trait and a cognitive problem? J Am Geriatr Soc. 2015;63(10):2001–7.Google Scholar
  18. 18.
    Lugaresi E, Plazzi G. Heavy snorer disease: from snoring to the sleep apnea syndrome--an overview. Respiration. 1997;64(Suppl 1):11–4.Google Scholar
  19. 19.
    Prentice AM, Jebb SA. Beyond body mass index. Obes Rev. 2001;2(3):141–7.Google Scholar
  20. 20.
    Frank AP, de Souza SR, Palmer BF, Clegg DJ. Determinants of body fat distribution in humans may provide insight about obesity-related health risks. J Lipid Res. 2018.  https://doi.org/10.1194/jlr.R086975.
  21. 21.
    Schafer H, Pauleit D, Sudhop T, Gouni-Berthold I, Ewig S, Berthold HK. Body fat distribution, serum leptin, and cardiovascular risk factors in men with obstructive sleep apnea. Chest. 2002;122(3):829–39.Google Scholar
  22. 22.
    El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ. 2014;186(1):E25–51.Google Scholar
  23. 23.
    Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3(7):737–47.Google Scholar
  24. 24.
    • Polese JF, Santos-Silva R, de Oliveira Ferrari PM, Sartori DE, Tufik S, Bittencourt L. Is portable monitoring for diagnosing obstructive sleep apnea syndrome suitable in elderly population? Sleep Breath. 2013;17(2):679–86 This is the first study that evaluated the diagnostic accuracy of PM in elderly population. Google Scholar
  25. 25.
    Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14(6):486–95.Google Scholar
  26. 26.
    Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med. 1998;157(1):144–8.Google Scholar
  27. 27.
    Malhotra A, Huang Y, Fogel R, Lazic S, Pillar G, Jakab M, et al. Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med. 2006;119(1):72 e9–14.Google Scholar
  28. 28.
    Aviv JE, Martin JH, Jones ME, Wee TA, Diamond B, Keen MS, et al. Age-related changes in pharyngeal and supraglottic sensation. Ann Otol Rhinol Laryngol. 1994;103(10):749–52.Google Scholar
  29. 29.
    Trinder J, Whitworth F, Kay A, Wilkin P. Respiratory instability during sleep onset. J Appl Physiol (1985). 1992;73(6):2462–9.Google Scholar
  30. 30.
    Pack AI, Silage DA, Millman RP, Knight H, Shore ET, Chung DC. Spectral analysis of ventilation in elderly subjects awake and asleep. J Appl Physiol. 1985;1988;64(3):1257–67.Google Scholar
  31. 31.
    Chowdhuri S, Pranathiageswaran S, Franco-Elizondo R, Jayakar A, Hosni A, Nair A, et al. Effect of age on long-term facilitation and chemosensitivity during NREM sleep. J Appl Physiol (1985). 2015;119(10):1088–96.Google Scholar
  32. 32.
    Lu H, Xu F, Rodrigue KM, Kennedy KM, Cheng Y, Flicker B, et al. Alterations in cerebral metabolic rate and blood supply across the adult lifespan. Cereb Cortex. 2011;21(6):1426–34.Google Scholar
  33. 33.
    Hoch CC, Reynolds CF 3rd, Monk TH, Buysse DJ, Yeager AL, Houck PR, et al. Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. Sleep. 1990;13(6):502–11.Google Scholar
  34. 34.
    Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. 1999;160(4):1101–6.Google Scholar
  35. 35.
    Rowley JA, Zhou XS, Diamond MP, Badr MS. The determinants of the apnea threshold during NREM sleep in normal subjects. Sleep. 2006;29(1):95–103.Google Scholar
  36. 36.
    Bucks RS, Olaithe M, Eastwood P. Neurocognitive function in obstructive sleep apnoea: a meta-review. Respirology. 2013;18(1):61–70.Google Scholar
  37. 37.
    Olaithe M, Bucks RS, Hillman DR, Eastwood PR. Cognitive deficits in obstructive sleep apnea: insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev. 2018;38:39–49.Google Scholar
  38. 38.
    •• Gosselin N, Baril AA, Osorio RS, Kaminska M, Carrier J. Obstructive sleep apnea and the risk of cognitive decline in older adults. Am J Respir Crit Care Med. 2019;199(2):142-48This persepective article depicts the most recent findings on the neurocognitive consequences of obstructive sleep apnea in the elderly. Google Scholar
  39. 39.
    Cirelli C. Sleep and synaptic changes. Curr Opin Neurobiol. 2013;23(5):841–6.Google Scholar
  40. 40.
    Liguori C, Mercuri NB, Izzi F, Romigi A, Cordella A, Sancesario G, et al. Obstructive sleep apnea is associated with early but possibly modifiable Alzheimer's disease biomarkers changes. Sleep. 2017;40(5).  https://doi.org/10.1007/s11325-018-1683-x.
  41. 41.
    Meerlo P, Mistlberger RE, Jacobs BL, Heller HC, McGinty D. New neurons in the adult brain: the role of sleep and consequences of sleep loss. Sleep Med Rev. 2009;13(3):187–94.Google Scholar
  42. 42.
    Rosenzweig I, Williams SC, Morrell MJ. The impact of sleep and hypoxia on the brain: potential mechanisms for the effects of obstructive sleep apnea. Curr Opin Pulm Med. 2014;20(6):565–71.Google Scholar
  43. 43.
    Kim H, Yun CH, Thomas RJ, Lee SH, Seo HS, Cho ER, et al. Obstructive sleep apnea as a risk factor for cerebral white matter change in a middle-aged and older general population. Sleep. 2013;36(5):709–15B.Google Scholar
  44. 44.
    •• Xie C, Zhu R, Tian Y, Wang K. Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open. 2017;7(12):e013983 This meta-analysis showed that only severe and moderate OSA, but not mild OSA were associated with an increased risk of vascular outcomes and all-cause mortality. Google Scholar
  45. 45.
    Zhou J, Camacho M, Tang X, Kushida CA. A review of neurocognitive function and obstructive sleep apnea with or without daytime sleepiness. Sleep Med. 2016;23:99–108.Google Scholar
  46. 46.
    Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, Ensrud KE, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011;306(6):613–9.Google Scholar
  47. 47.
    Osorio RS, Gumb T, Pirraglia E, Varga AW, Lu SE, Lim J, et al. Sleep-disordered breathing advances cognitive decline in the elderly. Neurology. 2015;84(19):1964–71.Google Scholar
  48. 48.
    Kaminska M, Mery VP, Lafontaine AL, Robinson A, Benedetti A, Gros P, et al. Change in cognition and other non-motor symptoms with obstructive sleep apnea treatment in Parkinson disease. J Clin Sleep Med. 2018;14(5):819–28.Google Scholar
  49. 49.
    • Martin MS, Sforza E, Roche F, Barthelemy JC, Thomas-Anterion C, group Ps. Sleep breathing disorders and cognitive function in the elderly: an 8-year follow-up study. the proof-synapse cohort. Sleep. 2015;38(2):179–87 This study showed that in healthy elderly subjects, various components of sleep breathing disorder at baseline were associated with small changes in selected cognitive functions specific to the attention domain after controlling for multiple comorbidities, such as sleepiness, hypertension, diabetes, anxiety, and depression. Google Scholar
  50. 50.
    Aloia MS, Ilniczky N, Di Dio P, Perlis ML, Greenblatt DW, Giles DE. Neuropsychological changes and treatment compliance in older adults with sleep apnea. J Psychosom Res. 2003;54(1):71–6.Google Scholar
  51. 51.
    Chowdhuri S, Quan SF, Almeida F, Ayappa I, Batool-Anwar S, Budhiraja R, et al. An Official American Thoracic Society research statement: impact of mild obstructive sleep apnea in adults. Am J Respir Crit Care Med. 2016;193(9):e37–54.Google Scholar
  52. 52.
    Lavie P, Lavie L. Unexpected survival advantage in elderly people with moderate sleep apnoea. J Sleep Res. 2009;18(4):397–403.Google Scholar
  53. 53.
    Cai Z, Manalo DJ, Wei G, Rodriguez ER, Fox-Talbot K, Lu H, et al. Hearts from rodents exposed to intermittent hypoxia or erythropoietin are protected against ischemia-reperfusion injury. Circulation. 2003;108(1):79–85.Google Scholar
  54. 54.
    Kolar F, Jezkova J, Balkova P, Breh J, Neckar J, Novak F, et al. Role of oxidative stress in PKC-delta upregulation and cardioprotection induced by chronic intermittent hypoxia. Am J Physiol Heart Circ Physiol. 2007;292(1):H224–30.Google Scholar
  55. 55.
    Javaheri S, Sharma RK, Wang R, Weng J, Rosen BD, Bluemke DA, et al. Association between obstructive sleep apnea and left ventricular structure by age and gender: the multi-ethnic study of atherosclerosis. Sleep. 2016;39(3):523–9.Google Scholar
  56. 56.
    Sforza E, Millasseau S, Hupin D, Barthelemy JC, Roche F. Arterial stiffness alteration and obstructive sleep apnea in an elderly cohort free of cardiovascular event history: the PROOF cohort study. Sleep Breath. 2018.  https://doi.org/10.1007/s11325-018-1683-x.
  57. 57.
    Martinez-Garcia MA, Campos-Rodriguez F, Catalan-Serra P, Soler-Cataluna JJ, Almeida-Gonzalez C, De la Cruz MI, et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. Am J Respir Crit Care Med. 2012;186(9):909–16.Google Scholar
  58. 58.
    Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352–60.Google Scholar
  59. 59.
    Munoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke. 2006;37(9):2317–21.Google Scholar
  60. 60.
    •• Stone KL, Blackwell TL, Ancoli-Israel S, Barrett-Connor E, Bauer DC, Cauley JA, et al. Sleep disordered breathing and risk of stroke in older community-dwelling men. Sleep. 2016;39(3):531–40 In this large study of community-dwelling elderly men enrolled in the MrOS Sleep Study, it was found that older men with severe nocturnal hypoxemia are at significantly increased risk of incident stroke. Measures of overnight oxygen saturation may better identify older men at risk for stroke than measures of apnea frequency. Google Scholar
  61. 61.
    Munoz R, Duran-Cantolla J, Martinez-Vila E, Gallego J, Rubio R, Aizpuru F, et al. Central sleep apnea is associated with increased risk of ischemic stroke in the elderly. Acta Neurol Scand. 2012;126(3):183–8.Google Scholar
  62. 62.
    Franklin KA, Sandstrom E, Johansson G, Balfors EM. Hemodynamics, cerebral circulation, and oxygen saturation in Cheyne-Stokes respiration. J Appl Physiol (1985). 1997;83(4):1184–91.Google Scholar
  63. 63.
    Del Brutto OH, Mera RM, Zambrano M, Castillo PR. Relationship between obstructive sleep apnea and neuroimaging signatures of cerebral small vessel disease in community-dwelling older adults. The Atahualpa Project. Sleep Med. 2017;37:10–2.Google Scholar
  64. 64.
    Ancoli-Israel S, Kripke DF, Klauber MR, Fell R, Stepnowsky C, Estline E, et al. Morbidity, mortality and sleep-disordered breathing in community dwelling elderly. Sleep. 1996;19(4):277–82.Google Scholar
  65. 65.
    Lavie P, Herer P, Peled R, Berger I, Yoffe N, Zomer J, et al. Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep. 1995;18(3):149–57.Google Scholar
  66. 66.
    Mant A, King M, Saunders NA, Pond CD, Goode E, Hewitt H. Four-year follow-up of mortality and sleep-related respiratory disturbance in non-demented seniors. Sleep. 1995;18(6):433–8.Google Scholar
  67. 67.
    Phillips BA, Berry DT, Schmitt FA, Harbison L, Lipke-Molby T. Sleep-disordered breathing in healthy aged persons: two- and three-year follow-up. Sleep. 1994;17(5):411–5.Google Scholar
  68. 68.
    Young T. Sleep-disordered breathing in older adults: is it a condition distinct from that in middle-aged adults? Sleep. 1996;19(7):529–30.Google Scholar
  69. 69.
    Johansson P, Alehagen U, Svanborg E, Dahlstrom U, Brostrom A. Clinical characteristics and mortality risk in relation to obstructive and central sleep apnoea in community-dwelling elderly individuals: a 7-year follow-up. Age Ageing. 2012;41(4):468–74.Google Scholar
  70. 70.
    Redline S. Age-related differences in sleep apnea: generalizability of findings in older population. In: Kuna ST, Suratt PM, Pemmers JE, editors. Sleep and respiration in aging adults. New York: Elsevier Science Publishing Company Inc.; m1991. p. 89–193.Google Scholar
  71. 71.
    Okuro M, Morimoto S. Sleep apnea in the elderly. Curr Opin Psychiatry. 2014;27(6):472–7.Google Scholar
  72. 72.
    Groth M. Sleep apnea in the elderly. Clin Geriatr Med. 2005;21(4):701–12 vi.Google Scholar
  73. 73.
    Janson C, Noges E, Svedberg-Randt S, Lindberg E. What characterizes patients who are unable to tolerate continuous positive airway pressure (CPAP) treatment? Respir Med. 2000;94(2):145–9.Google Scholar
  74. 74.
    Chong MS, Ayalon L, Marler M, Loredo JS, Corey-Bloom J, Palmer BW, et al. Continuous positive airway pressure reduces subjective daytime sleepiness in patients with mild to moderate Alzheimer's disease with sleep disordered breathing. J Am Geriatr Soc. 2006;54(5):777–81.Google Scholar
  75. 75.
    Pelletier-Fleury N, Rakotonanahary D, Fleury B. The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox's proportional hazard analysis. Sleep Med. 2001;2(3):225–32.Google Scholar
  76. 76.
    Aloia MS, Di Dio L, Ilniczky N, Perlis ML, Greenblatt DW, Giles DE. Improving compliance with nasal CPAP and vigilance in older adults with OAHS. Sleep Breath. 2001;5(1):13–21.Google Scholar
  77. 77.
    Lopez-Padilla D, Alonso-Moralejo R, Martinez-Garcia MA, De la Torre CS, Diaz de Atauri MJ. Continuous positive airway pressure and survival of very elderly persons with moderate to severe obstructive sleep apnea. Sleep Med. 2016;19:23–9.Google Scholar
  78. 78.
    Ou Q, Chen YC, Zhuo SQ, Tian XT, He CH, Lu XL, et al. Continuous positive airway pressure treatment reduces mortality in elderly patients with moderate to severe obstructive severe sleep apnea: a cohort study. PLoS One. 2015;10(6):e0127775.Google Scholar
  79. 79.
    Serrano Merino J, Perula de Torres LA, Bardwell WA, Munoz Gomez R, Roldan Villalobos A, Feu Collado N, et al. Impact of positive pressure treatment of the airway on health-related quality of life in elderly patients with obstructive sleep apnea. Biol Res Nurs. 2018;20(4):452–61.Google Scholar
  80. 80.
    Dalmases M, Sole-Padulles C, Torres M, Embid C, Nunez MD, Martinez-Garcia MA, et al. Effect of CPAP on cognition, brain function, and structure among elderly patients with OSA: a randomized pilot study. Chest. 2015;148(5):1214–23.Google Scholar
  81. 81.
    McMillan A, Bratton DJ, Faria R, Laskawiec-Szkonter M, Griffin S, Davies RJ, et al. Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial. Lancet Respir Med. 2014;2(10):804–12.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.John D. Dingell VA Medical CenterDetroitUSA

Personalised recommendations