A 78-year-old complains of snoring and fatigue and has a history of hypertension and of disruptive snoring for 10 years. His wife has witnessed apneas during sleep. The man has mild to moderate daytime sleepiness and the fatigue has progressed over the past 10 years. On polysomnography, he has an apnea-hypopnea index (AHI) of 18. His lowest registered oxygen saturation level is 82%. The test also shows no N3 sleep stage.
Explore This IssueJuly 2014
Cases like this force otolaryngologists to consider whether disturbances in sleep are the same in elderly patients as they are in younger patients, how to assess elderly sleep disturbances, and whether to recommend surgery. In the panel session “Issues You Cannot Ignore in Elderly Patients,” experts discussed these points and the importance of considering the frailty in this population.
Benefit of Surgical Treatment
Edward Weaver, MD, MPH, chief of sleep surgery at the University of Washington in Seattle, presented data that supports the idea that sleep disturbances in the elderly should be considered largely along the same lines as it is in middle-aged people, and that it presents the same burden of disease in both groups.
In one study, moderate-to-severe sleep apnea was found to independently confer six times the risk of mortality than in those with no sleep apnea (Sleep. 2008;31:1079-1085). Another study, using a cohort of tens of thousands of U.S. veterans, found that those who had sleep apnea treated experienced half the related mortality risk as those who did not have their sleep apnea treated (p<0.001) (Sleep. 2004;27:A208 [Abstract]).
When the veteran cohort was stratified by age, the researchers found that the risk of death related to sleep apnea was the same in the middle-aged cohort of 63,209 patients as in the geriatric cohort of 53,469 patients (p=0.17), and the beneficial effects of treatment on survival were the same in each cohort (Sleep. 2006;29:A215 [Abstract]). The risk of serious complication with surgery was low in both the middle-aged and geriatric cohorts (Laryngoscope. 2004;114:450-453.).
There is little research on the effects of surgery on symptoms and morbidities in the elderly per se, but Dr. Weaver said there is little reason to think it wouldn’t help. “Don’t ignore sleep apnea in the geriatric population,” Dr. Weaver said. “It can be significant and it can be treated.”
Proceed with Caution
Eric Kezirian, MD, MPH, professor of otolaryngology-head and neck surgery at the University of Southern California, suggested that sleep disordered breathing (SDB) might mean something different in the elderly than it does in middle-aged patients.