Original articleLong-term follow-up of sleep disordered breathing in older adults
Introduction
Epidemiological studies have shown that 15% of men and 5% of women between the ages of 30 and 60 years have sleep disordered breathing (SDB), defined as a respiratory disturbance index of 10 or greater [1]. Using a similar definition of an index of 20 or greater, adults over the age of 65 have considerably higher prevalence rates, reaching 70% for men and 56% for women [2]. Kripke et al. [3] found rates of 10.9% for men and 5.3% for women between the ages of 40 and 60 years using an index of 20 or greater based on oxygen desaturations. Untreated SDB can lead to negative consequences such as heart disease [4], hypertension [5], and shorter survival [6]. Change in weight can also effect the severity of SDB [7], with increased weight being associated with increased severity of SDB. Recent studies have suggested that people with even mild SDB are at greater risk at follow-up for developing hypertension [8], [9].
The amount of apnea frequently varies from night to night [3], so evidently some variation will be observed from year to year [3]. Few studies have followed untreated people with SDB over long time periods. One limitation of the existing literature is that there has been little or no follow-up of untreated patients beyond 5 years. In addition, most studies followed fairly small samples which were selected based on specific criteria such as an initial severity of SDB. These factors may have limited the generalizability of these findings to the older population at large.
Ancoli-Israel and colleagues began studying a large cohort of 427 randomly selected community-dwelling elderly in 1981 [2]. The results from the first visit showed that sleep apnea was extremely common with 24% of the sample meeting a criterion of five or more apneas per hour of sleep, and the majority having greater than ten per hour [2]. The sleep apnea was associated with self-report of nocturnal wandering or confusion, reports of breathing cessation at night, increased daytime sleepiness, greater weight, and more depression. A subset of the sample was followed and re-studied repeatedly. At the first 8.5 year follow-up, there were no significant changes in apnea index (AI) or respiratory disturbance index (RDI) from the initial recording [10]. The current study was designed to determine whether, with increasing age, sleep apnea improved, became worse, or stayed the same.
Section snippets
Subjects
The community-dwelling elderly sample consisted of 427 men and women over the age of 65 years in the San Diego metropolitan area who were randomly selected and studied between 1981 and 1985 [2]. Participants were screened over the telephone and then extensively interviewed in their homes about sleep and health. All had one or two overnight sleep recordings in their home. Beginning in 1985, those with the more severe SDB were re-contacted every 2 years and asked to participate again in
Results
There was no statistically significant effect of age on RDI (t201=−0.91, P=0.3651); that is, RDI did not consistently change with age. Fig. 1, Fig. 2 show the individual fitted regression lines of RDI vs. age for women and men, respectively. Multiple linear regression showed that three variables were associated with change in RDI: BMI at initial visit (P=0.001), change in BMI (P=0.02), and a consistent self-report of high blood pressure (P=0.005). These effects were slight, with R2 values of
Discussion
Several studies have followed small cohorts of older adults over time periods of up to 5 years and have reported either small changes or no change in SDB over time. The current study found similar results in a larger cohort studied over an 18-year period. With increasing age, RDI stayed relatively stable. Any changes seen in RDI were not a function of age, but rather a function of changes in BMI.
Bliwise et al. followed older subjects for 2.8 years and found a slight worsening of apnea index
Acknowledgements
Supported by NIA AG02711, NIA AG08415, NCI CA85264, NHLBI HL44915, the Sam and Rose Stein Institute for Research on Aging, the Department of Veterans Affairs VISN-22 Mental Illness Research, Education and Clinical Center (MIRECC), the UCSD Cancer Center, and the Research Service of the Veterans Affairs San Diego Healthcare System. We would like to acknowledge the help of Andrea Chin, Einat Estline, Robert Fell and Linda Parker.
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2017, Sleep MedicineCitation Excerpt :In our whole patient population, AHI increased with increasing age, which is in line with previous studies [3–5]. However, the effect of the age on AHI diminished when it was contemplated within different OSA severity categories (only in the moderate OSA category the association was statistically significant) and this is also supported by the previous studies showing that AHI does not increase with age [7,8]. These results may be explained by the fact that ratio of prevalence of having moderate or severe OSA between younger and older patients is higher compared to the ratio of having mild OSA [1] and, therefore, association between AHI and age is statistically significant in the whole population.