Diagnosis

Because EDS and snoring are common in the older population as well as being the two main clinical features of SDB, it is extremely important that clinicians do not directly assume that if an older adult has complains of snoring or EDS, that these complaints must be due to SDB, nor should they assume that snoring or EDS are normal signs of aging. A complete evaluation is always warranted.

A step-wise assessment process is suggested to accurately determine the presence of SDB in the elderly. First, a complete sleep history should be obtained, including symptoms of SDB, symptoms of other sleep disorders (e.g., restless leg syndrome), sleep-related habits and routines and, if possible, bed-partner testimonials. Secondly, the patient's medical history, including psychiatric and medical records, should be reviewed. Particular attention should be given to associated medical conditions and medications, the use of alcohol, and evidence of cognitive impairment. Lastly, if from the evidence gathered there is reason to suspect SDB, an overnight polysomnographic recording should be obtained.

The diagnosis of SDB requires an overnight polysomnogram. There may be some potential challenges in obtaining sleep studies in the elderly including difficulties with transportation, worries regarding technical equipment, understanding complicated instructions, and resistance to spending the night in an unfamiliar environment. These difficulties may be eased by offering straightforward and thorough education about the sleep recording process, anticipation of the potential difficulties implicated, and involvement of the patient's spouse or caregiver in the process. If the clinician has a high suspicion of SDB, an unattended overnight sleep study may be sufficient for diagnosis. However, it is important to note that Medicare currently reimburses only attended sleep studies.

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