Conclusions

SDB is a common condition in the elderly and is associated with complaints of EDS and snoring. The more severe cases also may present with cognitive impairments and daytime dysfunction. Although the cutoff has not yet been established, there is evidence that beyond some pathologic level of SDB, treatment is clearly beneficial. The most common treatment for SDB is CPAP, which has been shown to be both effective and acceptable in the older population.

There is a growing body of literature exploring SDB in the elderly. There is an ongoing debate in the field as to whether SDB in the elderly is a distinct pathologic condition, different than that of middle-age adults. Levy et al. (78) in a study of approximately 400 people of all ages (ranging from < 20 years to > 85 years old) reported that the severity of SDB based on AHI and oxygen saturation did not differ in those subjects 65 years of age or older when compared to those subjects < 65 years of age. However, in this study, the symptomatology and sequelae related to SDB were not reported and therefore, age differences in regards to the correlates and possible consequences of SDB were not investigated.

Some of the differences in severity found between younger and older adults might be due to correlates of older age that affect the SDB, rather than intrinsic SDB differences between the different age populations. For example, Bixler et al. (9) found that BMI is a central factor that affects SDB severity. In this study, the prevalence of SDB was higher in older men compared to younger men, however, after controlling for BMI, the severity of SDB based on number of events and oxygen saturation actually decreased with age. Furthermore, Ancoli-Israel et al. (21) in an 18-year follow-up study with more than 400 elderly patients with SDB showed that AHI did not continue to increase with age if the patient's BMI remained stable.

Controversy also exists regarding the effect of SDB on morbidity and mortality in the elderly since the research findings are at times contradictory. As discussed previously, there are several reports of increased mortality in elderly with SDB (64).

Ancoli-Israel et al. (65) found that elderly subjects with more severe SDB had significantly shorter survival, dying as soon as two years earlier, than those with mildmoderate or no SDB. On the contrary, He et al. (79) reported that an AHI > 20 predicted increased mortality in SDB patients under 50 but not those over 50. Similarly, others have reported that the survival rate is reduced in middle-aged patients with SDB compared to age- and sex-matched controls, but that this pattern was not seen among older patients (80,81). Finally, Mant et al. (66) found SDB severity (RDI > 15) did not predict death in nondemented, independent living elderly.

Because most of the literature on SDB is based on middle-aged males, many questions about the phenomenology of SDB in other populations, including older adults in general and older women in specific, remain to be clarified. Particularly, questions that still need to be answered are whether SDB in the elderly is indeed a different disorder, and if not, the degree to which SDB might differ in younger compared to older adults.

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