Older Americans often are at high risk for obstructive sleep apnea (OSA), yet they remain vastly underdiagnosed, according to the University of Michigan. Its researchers report that 56% of those who are 65 and older have a high risk of OSA, yet only 8% of them have been tested for it. An overnight sleep study is required for diagnosis.
“It appears most older adults who are at risk for obstructive sleep apnea may not be getting referred for overnight sleep studies, and we may be missing an important chance for treatment,” said Tiffany Braley, MD, MS, assistant professor of neurology at Michigan Medicine and co-first author of the study.
The researchers examined data from 1,052 Medicare beneficiaries who completed a series of sleep questions and other surveys as part of the National Health and Aging Trends Study (NHATS), which is representative of more than 7 million Americans.
“We see that OSA was rarely evaluated, but when it was, it was almost always confirmed, as nearly all—94%—of those at risk and tested for OSA were diagnosed,” said Galit Levi Dunietz, PhD, MPH, co-first author and postdoctoral research fellow in sleep epidemiology at Michigan Medicine’s Sleep Disorders Center. “This suggests an opportunity to increase the evaluation among older Americans.
The NHATS survey questions about sleep resembled STOP-Bang, a popular questionnaire used in the clinical setting to evaluate common OSA risk factors. The survey evaluated whether respondents were at an advanced age, snored, were overweight, were male, had high blood pressure, and felt fatigued.
Among the 94% of those who received a diagnosis after being deemed at risk and given a sleep study, 82% of their physicians prescribed the first-line treatment, continuous positive airway pressure, which sends pressurized air through the nose or nose and mouth to the throat to keep it from collapsing during sleep.
“It was good to see a high treatment rate after diagnosis, so the main concern is the underdiagnosis of OSA,” Dunietz.
“We know that OSA is quite common, yet often underdiagnosed in adults in the US,” Braley said. “But most of the data available are from younger or middle-aged patients.”
In the young and middle-aged populations, OSA is linked to significant health risks and can worsen quality of life. But in addition to a lack of data on the prevalence of OSA in the older population, Braley says more research is needed to confirm whether the consequences are the same for OSA in older adults.
“This is an important first step in getting to the heart of the question. What is the national scope of OSA, and our ability to recognize it, in all age groups?” said Braley.
“If we can assume that older adults are subject to the same risks of OSA as middle-aged adults, then missing a diagnosis could ultimately lead to a higher risk of conditions like hypertension, stroke, heart disease, diabetes, and depression, as well as cognitive impairment, which is especially important for older individuals,” said Braley. “These conditions have serious impact and lead to expensive medical care.”
Some older patients may not realize their snoring, sleepiness, tiredness, and other symptoms of OSA could be because of something than normal aging. Those already dealing with health conditions such as obesity, diabetes, stroke, a previous heart attack, and high blood pressure are more likely to experience OSA as well, the researchers said.
“The results of this study are impressive. They amount to estimates, but even so, they help to quantify the magnitude of the challenge,” said coauthor Ronald Chervin, MD, MS, professor of neurology and director of the Sleep Disorders Center.
“We already know that untreated sleep apnea costs billions each year, with decreased work productivity, impaired quality of life, and increased medical costs,” Chervin said. “We still need to learn about the impact of OSA in older persons more specifically, but the findings of the study suggest a huge, untapped opportunity to improve lives in older years, and perhaps medical costs as well, through more effective diagnosis, and then treatment, of OSA.”
The study, “Recognition and Diagnosis of Obstructive Sleep Apnea in Older Americans,” was published by the Journal of the American Geriatrics Society.
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