Sleep-Related Breathing Disorders in the Elderly

摘要

Sleep-disordered breathing (SDB) is common in elderly with reported prevalence rates of 20-81%. Snoring and excessive daytime sleepiness (EDS) are the two principal symptoms of SDB, with insomnia, nocturnal confusion, and daytime cognitive impairment being less common presentations. The mortality and morbidity associated with SDB remain unclear in the elderly. In evaluating an elderly patient with questionable SDB a thorough sleep history needs to be taken, if possible in the presence of a bed partner or caregiver, focusing on symptoms of SDB and other sleep disorders. Unintentional napping may be a clue that a patient has SDB. If history is suggestive of SDB, an overnight sleep recording should be obtained. Initiation of treatment in older patients should be guided by the significance of the patient's symptoms and the severity of the SDB. Patients with more severe SDB deserve a trial of treatment. For those with milder levels of SDB, treatment should be considered if co-morbid conditions are present, such as hypertension, cognitive dysfunction, or EDS. Age alone, or assumed treatment noncompliance, should never be reasons to withhold treatment.