COSM14: Sleep Disturbances Not To Be Overlooked in Elderly Otolaryngology Patients

A major study published in 2000 found that SDB was associated with a 64% increased risk of hypertension in those younger than 65 years of age but had no association for those 65 years of age and older (JAMA. 2000;283:1829-1836).

In another study, which Dr. Kezirian called the most detailed longitudinal study attempting to determine whether untreated AHI is associated with mortality, 331 men with SDB were compared with controls who did not have SDB. AHI was assessed as a predictor of death, with adjustments for medical comorbidities. For those younger than age 62, the prime risk factors were chronic obstructive pulmonary disease and diabetes, with an interaction between AHI and body-mass index. For those aged 62 and older, AHI did not appear to be an independent risk factor (J Sleep Res. 2007;16:128-134).

Symptoms such as daytime sleepiness may indicate the older adults who have the highest risk for mortality. A 2011 study of older men showed that those with both OSA and daytime sleepiness had more than double the risk of mortality over time when compared with those who had OSA alone, daytime sleepiness alone, or neither (Sleep. 2011;34:435-442).

Dr. Kezirian indicated that the impact of age on surgical outcomes has not been studied carefully. There are only two small studies that have done this, and the very limited evidence suggests that older patients may not do as well, at least in improving the AHI with surgery. He stressed that more work needs to be done to examine outcomes in older adults, as is common to so many medical fields.

“We need to appreciate the individual distinguishing characteristics of our patients,” Dr. Kezirian said. “It’s true in young and middle aged adults, too. We don’t treat mild sleep apnea with the same urgency as we do for severe obstructive sleep apnea. We treat patients who are tired differently from those who are not. We need to understand the consequences of sleep apnea in older adults and the benefits of surgical treatment.”

Frailty

Robert J. Stachler, MD, clinical associate professor of otolaryngology-head and neck surgery at Henry Ford Medical Group in Detroit, underscored the importance of considering a patient’s degree of frailty in deciding whether to perform surgery.

In a Norwegian study, researchers examined 171 consecutive patients who were at least 70 years old and who had undergone surgery for colorectal cancer. Patients who were considered frail before the surgery had a four-fold risk of post-operative complications than those not considered frail. Frailty also was a significant predictor of surgical complications and medical complications after surgery (Crit Rev Oncol Hematol. 2010;76:208-217).