Características clínicas del síndrome de apneas obstructivas del sueño en el adulto mayor

Abstract

Obstructive sleep apnea syndrome (OSAS) is a prevalent and often underdiagnosed health problem in the elderly. Objectives: To describe clinical characteristics and sleep disorders in adults over 65 years-old compared to a cohort of young adults (18-64 years-old) with OSAS. Methods: Prospective clinical study carried out in snoring subjects attended in a sleep clinic, to whom sleep questionnaires were administered and respiratory polygraphy or polysomnography was performed to confirm the diagnosis of OSAS. Clinical characteristics and sleep-disordered breathing were compared among both cohorts. Results: 1,512 patients were evaluated, mean age: 56 ± 14 years, 70% male, 91.2% had comorbidities and 70.3% had moderate-severe OSAS. The classic symptoms of OSAS were less reported in older adults: snoring (81.2% vs 86.4%, p < 0.02), witnessed apneas (69.6% vs 79.8%, p < 0.001), daytime fatigue (54.8% vs 77.3%, p < 0.001), unrefreshing sleep (75.6% vs 89.6%, p < 0.001), nocturnal choking (38.1% vs 50.7%, p < 0.001) and excessive daytime sleepiness (43.9% vs 51.2%, p < 0.013). In the elderly, comorbidities were more frequent, especially chronic cardiovascular, respiratory and metabolic diseases; while obesity as measured by anthro­pometric data (body mass index, cervical circumference and waist-hip ratio), microarousal index, desaturation index (ID3%) and apnea-hypopnea index were similar in both groups. The magnitude of nocturnal hypoxemia observed in pulse oximetry (mean SaO2, minimum SaO2 and CT90%) was higher in the elderly. Conclusion: Clinical manifestations, comorbidities and sleep breathing disor­ders are different in the elderly with obstructive sleep apnea syndrome, which should be considered in the diagnostic process and treatment planning.