Portal de Periódicos da CAPES

Sleep Apnea: A Geriatric Syndrome

2017; Elsevier BV; Volume: 18; Issue: 11 Linguagem: Inglês

10.1016/j.jamda.2017.08.020

1538-9375

John E. Morley, Angela M. Sanford, R. E. Bourey,

Cardiovascular and Diving-Related Complications

President William Howard Taft and Joe, the fat boy who was always asleep in Dickens' The Posthumous Papers of the Pickwick Club are 2 of the most famous examples of obstructive sleep apnea syndrome (Figure 1, A). Ondine's curse in which she told her unfaithful husband that as long as he was awake he would breathe, but if he fell asleep his breath would desert him, is representative of central sleep apnea (Figure 1, B). Sleep apnea as diagnosed by apneic and hypopneic episodes per hour of sleep [ie, apnea-hypopnea index (AHI)] is most prevalent in older persons and especially those in nursing homes. 2 Neikru A.B. Ancoli-Israel S. Sleep disorders in the older adults—A mini-review. Gerontology. 2010; 56: 181-189 Crossref PubMed Scopus (287) Google Scholar In 1 study of community-dwelling older persons, 44% had an AHI ≥20, indicating moderate to severe sleep apnea. 3 Ancoli-Israel S. Long-term follow-up of sleep disordered breathing in older adults. Sleep Med. 2001; 2: 511-516 Crossref PubMed Scopus (75) Google Scholar The Sleep Heart Health Study found that at least 20% of persons over 60 years of age had an AHI ≥15. 4 Young T. Shaher E. Nieto F.J. et al. Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health study. Arch Intern Med. 2002; 162: 893-900 Crossref PubMed Scopus (1031) Google Scholar Although sleep apnea is rarely documented in nursing home residents (<1%), 5 Resnick H.E. Phillips B. Documentation of sleep apnea in nursing homes: United States 2004. J Am Med Dir Assoc. 2008; 9: 260-264 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar it occurs in 25%–50% of this patient population, making it a widespread condition. 6 Ancoli-Israel S. Klauber M.R. Kripke D.F. et al. Sleep apnea in female patients in a nursing home increased risk of mortality. Chest. 1989; 96: 1054-1058 Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar , 7 Cohen-Zion M. Stepnowsky M. Marler et al. Changes in cognitive function associated with sleep disordered breathing in older people. J Am Geriatr Soc. 2001; 49: 1622-1627 Crossref PubMed Google Scholar , 8 Morley J.E. Sleep and the Nursing Home. J Am Med Dir Assoc. 2015; 16: 539-543 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Although night time observation of apneic episodes by nursing staff has excellent sensitivity and specificity for recognizing sleep apnea in the nursing home, 9 Onen S.H. Dubrey C. Decullier E. et al. Observation-based nocturnal sleep inventory: Screening tool for sleep apnea in elderly people. J Am Geriatr Soc. 2008; 56: 1920-1925 Crossref PubMed Scopus (23) Google Scholar definitive diagnosis in this setting can be made by overnight oximetry 6 Ancoli-Israel S. Klauber M.R. Kripke D.F. et al. Sleep apnea in female patients in a nursing home increased risk of mortality. Chest. 1989; 96: 1054-1058 Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar , 9 Onen S.H. Dubrey C. Decullier E. et al. Observation-based nocturnal sleep inventory: Screening tool for sleep apnea in elderly people. J Am Geriatr Soc. 2008; 56: 1920-1925 Crossref PubMed Scopus (23) Google Scholar or a variety of more sophisticated home sleep monitors. 10 Jones D.E. Amick H.R. Feltner C. et al. Screening for obstructive sleep apnea in adults: An evidence review for the U.S. Preventive Services Task Force (Internet). U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews, Rockville, MD2017 Crossref Scopus (159) Google Scholar