Background: There are just a few epidemiological studies on sleep-disordered breathing (SDB) in the elderly, and the results are inconsistent. Study Objectives: We sought to investigate the prevalence of and risk factors for SDB in a representative elderly population with the use of attended nocturnal polysomnography (NPSG). Methods: Among 6,959 individuals aged ≥60 years living in Yongin City, Korea, 696 subjects were selected using random sampling. All the subjects were invited to visit a hospital for NPSG, and SDB was defined as an apnea-hypopnea index ≥15. Results: Of the 696 participants investigated, 348 participants completed the sleep study and clinical evaluation. SDB was observed in 127 of the 348 participants, and the prevalence of SDB was 36.5% (52.6% in males and 26.3% in females). A body mass index ≥25 was associated with SDB in both male and female subjects, particularly in males, whereas snoring was independently associated with SDB in female participants only. In male participants, SDB was a significant risk factor for hypertension (p = 0.025). Conclusions: SDB was found to be common among elderly Koreans, and it was more prevalent and severe in male than in female subjects. Health consequences of SDB in the elderly need to be further explored.

Keywords:
Apnea/hypopnea index, Body mass index, Elderly, Polysomnography, Sleep-disordered breathing, Snoring
1.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S: The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-1235.
2.
Bearpark H, Elliott L, Grunstein R, Cullen S, Schneider H, Althaus W, Sullivan C: Snoring and sleep apnea. A population study in Australian men. Am J Respir Crit Care Med 1995;151:1459-1465.
3.
Ju G, Yoon IY, Lee SD, Kim YK, Yoon E, Kim JW: Modest changes in cerebral glucose metabolism in patients with sleep apnea syndrome after continuous positive airway pressure treatment. Respiration 2012;84:212-218.
4.
Lugaresi E, Plazzi G: Heavy snorer disease: from snoring to the sleep apnea syndrome - an overview. Respiration 1997;64(suppl 1):11-14.
5.
Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D'Agostino RB, Newman AB, Lebowitz MD, Pickering TG: Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283:1829-1836.
6.
Peppard PE, Young T, Palta M, Skatrud J: Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-1384.
7.
Shamsuzzaman AS, Gersh BJ, Somers VK: Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003;290:1906-1914.
8.
Büchner NJ, Quack I, Woznowski M, Stähle C, Wenzel U, Rump LC: Microvascular endothelial dysfunction in obstructive sleep apnea is caused by oxidative stress and improved by continuous positive airway pressure therapy. Respiration 2011;82:409-417.
9.
Ip MS, Lam B, Lauder IJ, Tsang KW, Chung KF, Mok YW, Lam WK: A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong. Chest 2001;119:62-69.
10.
Kim J, In K, You S, Kang K, Shim J, Lee S, Lee J, Park C, Shin C: Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med 2004;170:1108-1113.
11.
Grunstein R, Wilcox I, Yang TS, Gould Y, Hedner J: Snoring and sleep apnoea in men: association with central obesity and hypertension. Int J Obes Relat Metab Disord 1993;17:533-540.
12.
Scrima L, Broudy M, Nay KN, Cohn MA: Increased severity of obstructive sleep apnea after bedtime alcohol ingestion: diagnostic potential and proposed mechanism of action. Sleep 1982;5:318-328.
13.
Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM: Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 2002;162:893-900.
14.
Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O: Sleep-disordered breathing in community-dwelling elderly. Sleep 1991;14:486-495.
15.
Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A: Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998;157:144-148.
16.
Sforza E, Chouchou F, Collet P, Pichot V, Barthelemy JC, Roche F: Sex differences in obstructive sleep apnoea in an elderly French population. Eur Respir J 2011;37:1137-1143.
17.
Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, Kales A: Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001;163:608-613.
18.
Duran J, Esnaola S, Rubio R, Iztueta A: Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 2001;163:685-689.
19.
Zamarron C, Gude F, Otero Y, Alvarez JM, Golpe A, Rodriguez JR: Prevalence of sleep disordered breathing and sleep apnea in 50- to 70-year-old individuals. A survey. Respiration 1999;66:317-322.
20.
Iber C, Redline S, Kaplan Gilpin AM, Quan SF, Zhang L, Gottlieb DJ, Rapoport D, Resnick HE, Sanders M, Smith P: Polysomnography performed in the unattended home versus the attended laboratory setting - Sleep Heart Health Study methodology. Sleep 2004;27:536-540.
21.
Portier F, Portmann A, Czernichow P, Vascaut L, Devin E, Benhamou D, Cuvelier A, Muir JF: Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am J Respir Crit Care Med 2000;162:814-818.
22.
Naing L, Winn T, Rusli B: Practical issues in calculating the sample size for prevalence studies. Arch Orofacial Sci 2006;1:9-14.
23.
Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM: STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108:812-821.
24.
Rechtschaffen A, Kales A: A Manual of Standardized Terminology, Techniques, and Scoring System for Sleep Stages of Human Subjects. Los Angeles, University of California Brain Information Service/Brain Research Institute, 1968.
25.
American Academy of Sleep Medicine Task Force: Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-689.
26.
Ballester E, Badia JR, Hernandez L, Farre R, Navajas D, Montserrat JM: Nasal prongs in the detection of sleep-related disordered breathing in the sleep apnoea/hypopnoea syndrome. Eur Respir J 1998;11:880-883.
27.
Hernandez L, Ballester E, Farre R, Badia JR, Lobelo R, Navajas D, Montserrat JM: Performance of nasal prongs in sleep studies: spectrum of flow-related events. Chest 2001;119:442-450.
28.
Norman RG, Ahmed MM, Walsleben JA, Rapoport DM: Detection of respiratory events during NPSG: nasal cannula/pressure sensor versus thermistor. Sleep 1997;20:1175-1184.
29.
Series F, Marc I: Nasal pressure recording in the diagnosis of sleep apnoea hypopnoea syndrome. Thorax 1999;54:506-510.
30.
Lin CM, Davidson TM, Ancoli-Israel S: Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev 2008;12:481-496.
31.
Jordan AS, Wellman A, Edwards JK, Schory K, Dover L, MacDonald M, Patel SR, Fogel RB, Malhotra A, White DP: Respiratory control stability and upper airway collapsibility in men and women with obstructive sleep apnea. J Appl Physiol 2005;99:2020-2027.
32.
Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T: Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 2005;165:2408-2413.
33.
Hoban TF, Bliwise DL: Obstructive Sleep Apnea: Pathophysiology, Comorbidities and Consequences. New York, Informa Healthcare, 2007.
34.
Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, Quan SF: Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol 2001;154:50-59.
35.
Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A: Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab 2005;90:4510-4515.
36.
Kaneita Y, Ohida T, Uchiyama M, Takemura S, Kawahara K, Yokoyama E, Miyake T, Harano S, Suzuki K, Yagi Y, Kaneko A, Tsutsui T, Akashiba T: Excessive daytime sleepiness among the Japanese general population. J Epidemiol 2005;15:1-8.
37.
Chung S, Yoon IY, Lee CH, Kim JW: Effects of age on the clinical features of men with obstructive sleep apnea syndrome. Respiration 2009;78:23-29.
38.
Morrell MJ, Finn L, McMillan A, Peppard PE: The impact of ageing and sex on the association between sleepiness and sleep disordered breathing. Eur Respir J 2012;40:386-393.
39.
Endeshaw Y: Clinical characteristics of obstructive sleep apnea in community-dwelling older adults. J Am Geriatr Soc 2006;54:1740-1744.
40.
Pack AI, Dinges DF, Gehrman PR, Staley B, Pack FM, Maislin G: Risk factors for excessive sleepiness in older adults. Ann Neurol 2006;59:893-904.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.