Obstructive Sleep Apnea in the Elderly: A Distinct Entity?

Introduction: Elderly patients have age-related changes, anatomical and physiological, that predispose to obstructive sleep apnea (OSA). Symptoms and long-term consequences of OSA might differ from younger patients, but more studies are required.

Objectives: To compare the characteristics of OSA in the elderly and younger patients.

Methods: Retrospective study including patients with OSA (apnea hypopnea index, AHI, ≥5 with symptoms/comorbidities or ≥15), divided in two groups: elderly (≥65 years) and younger patients (<65 years), selected from Pulmonology consultation.

Results: A cohort of 328 patients with OSA was selected. In the elderly group (n=92), there were higher body mass index (BMI=29.9±8 kg/m2), Mallampati class IV (55%), Beck depression score (median 9±15), complaints of nocturia, erectile dysfunction and impaired libido. On the other hand, daily somnolence, respiratory pauses, snoring and headaches were more prevalent in younger patients. Sleep study results revealed higher wakes after sleep onset (WASO=119±56 minutes, p=0,253) and AHI (22±26, p<0,001) in the elderly group. There was a positive correlation between AHI and BMI (r=0,163; p=0,004), AHI and age (r=0,202; p<0,001). There were lower minimal (80±13%, p=0,004) and mean saturation values (92±4%, p<0,001) in this group. Older patients also had a statistically higher prevalence of severe OSA (38%, p<0,001).

Conclusions: In this analysis, we found significant differences in symptoms and sleep study results, between young and older patients. We infer that OSA in the elderly might be a different entity that requires a different management.

Keywords: obstructive sleep apnea; elderly; management