scholarly journals Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

2016 ◽  
Vol 48 (4) ◽  
pp. 992-1018 ◽  
Author(s):  
Nikolaus C. Netzer ◽  
Sonia Ancoli-Israel ◽  
Donald L. Bliwise ◽  
Stephany Fulda ◽  
Christine Roffe ◽  
...  
Keyword(s):  
Older Adults ◽  
Patient Group ◽  
Frail Elderly ◽  
Sleep Disordered Breathing ◽  
Consensus Statement ◽  
Task Force ◽  
Sleep Medicine ◽  
Specific Patient ◽  
Published Evidence ◽  
Disordered Breathing

Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulatedviadiscussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group.

scholarly journals Sleep-Disordered Breathing Is Associated With Impaired Odor Identification in Older U.S. Adults

2020 ◽  
Author(s):  
Jesse K Siegel ◽  
Xiandao Yuan ◽  
Kristen E Wroblewski ◽  
Martha K McClintock ◽  
Jayant M Pinto
Keyword(s):  
Older Adults ◽  
Central Nervous System ◽  
Nervous System ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Sleep Disordered Breathing ◽  
Odor Identification ◽  
Odor Sensitivity ◽  
Disordered Breathing

Abstract Background Sleep-disordered breathing (SDB) is a common, underdiagnosed condition in older adults with major health consequences, including disrupted central nervous system functioning. Whether SDB may affect sensory function is unclear. We sought to address this question by comparing 2 forms of olfactory testing which measure peripheral and central olfactory processing. Methods We assessed SDB (survey-reported snoring frequency, nighttime apneic events, or diagnosis of sleep apnea) in the National Social Life, Health, and Aging Project, a nationally representative sample of older U.S. adults. Odor sensitivity (peripheral) and odor identification (central) were assessed with validated instruments. Logistic regression was used to test the relationship between SDB and olfaction, accounting for relevant covariates, including demographics, cognition, and comorbidity. Results Twenty-nine percent of older U.S. adults reported symptoms of SDB (apneic events or nightly snoring). Of these, only 32% had been diagnosed with sleep apnea. Older adults with SDB (those who reported symptoms or have been diagnosed with sleep apnea) were significantly more likely to have impaired odor identification (odds ratio 2.13, 95% confidence interval 1.19–3.83, p = .012) in analyses that accounted for age, gender, race/ethnicity, education, cognition, comorbidities (including depression), and body mass index. Presence of SDB was not associated with impaired odor sensitivity (odds ratio 1.03, 95% confidence interval 0.75–1.43, p = .84). Conclusion SDB is highly prevalent but underdiagnosed in older U.S. adults and is associated with impaired odor identification but not odor sensitivity. These data support the concept that SDB affects pathways in the central nervous system which involve chemosensory processing.

scholarly journals Dorsolateral prefrontal cortex GABA deficit in older adults with sleep-disordered breathing

2017 ◽  
Vol 114 (38) ◽  
pp. 10250-10255 ◽  
Author(s):  
Ana C. Pereira ◽  
Xiangling Mao ◽  
Caroline S. Jiang ◽  
Guoxin Kang ◽  
Sara Milrad ◽  
...  
Keyword(s):  
Older Adults ◽  
Prefrontal Cortex ◽  
Cognitive Decline ◽  
Dorsolateral Prefrontal Cortex ◽  
Sleep Disordered Breathing ◽  
Apnea Hypopnea Index ◽  
Resonance Spectroscopy ◽  
1H Mrs ◽  
Dorsolateral Prefrontal ◽  
Disordered Breathing

Sleep-disordered breathing (SDB) is a common disorder in aging that is associated with cognitive decline, including significant executive dysfunction, for which the neurobiological underpinnings remain poorly understood. Using proton magnetic resonance spectroscopy (1H MRS), this study assessed whether dysregulation of the homeostatic balance of the major inhibitory and excitatory amino acid neurotransmitter systems of γ-aminobutyric acid (GABA) and glutamate, respectively, play a role in SDB. Levels of GABA and those of the combined resonances of glutamate and glutamine (Glx), were measured by 1H MRS in the left dorsolateral prefrontal cortex (l-DLPFC) and bilateral hippocampal regions of 19 older adults (age ± SD: 66.1 ± 1.9 years) with moderate to severe SDB, defined as having an Apnea–Hypopnea Index (AHI) greater than 15 as assessed by polysomnography, and in 14 older adults (age ± SD: 62.3 ± 1.3 years) without SDB (AHI < 5). In subjects with SDB, levels of l-DLPFC GABA, but not Glx, were significantly lower than in control subjects (P< 0.0002). Additionally, there was a negative correlation between l-DLPFC GABA levels, but not Glx, and SDB severity by AHI (r= -0.68,P< 0.0001), and a positive correlation between l-DLPFC GABA levels, but not Glx, and minimal oxygen saturation during sleep (r= 0.62,P= 0.0005). By contrast, no group differences or oxygenation associations were found for levels of GABA or Glx in right or left hippocampal region. These findings are interpreted in terms of a pathophysiological model of SDB in which hypoxia-mediated inhibitory neurotransmission deficit in DLPFC could lead to hyperexcitability and, potentially neuronal dysfunction and cognitive decline.

scholarly journals Sleep-Disordered Breathing and White Matter Disease in the Brainstem in Older Adults

SLEEP ◽  
2004 ◽  
Vol 27 (3) ◽  
pp. 474-479 ◽  
Author(s):  
Jingzhong Ding ◽  
F. Javier Nieto ◽  
Norman J. Beauchamp ◽  
Tamara B. Harris ◽  
John A. Robbins ◽  
...  
Keyword(s):  
Older Adults ◽  
White Matter ◽  
Sleep Disordered Breathing ◽  
White Matter Disease ◽  
Disordered Breathing

scholarly journals Sleep Disordered Breathing with Excessive Daytime Sleepiness is a Risk Factor for Mortality in Older Adults

SLEEP ◽  
2011 ◽  
Vol 34 (4) ◽  
pp. 435-442 ◽  
Author(s):  
Nalaka S. Gooneratne ◽  
Kathy C. Richards ◽  
Marshall Joffe ◽  
Regina W. Lam ◽  
Fran Pack ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Factor ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Disordered Breathing ◽  
Disordered Breathing

Obstructive sleep disordered breathing in children – an important problem in the light of current European guidelines

2018 ◽  
Vol 72 (5) ◽  
pp. 9-16 ◽  
Author(s):  
Antoni Krzeski ◽  
Marcin Burghard
Keyword(s):  
American Academy ◽  
Sleep Disordered Breathing ◽  
Task Force ◽  
Sleep Apnea Syndrome ◽  
Scientific Data ◽  
Growth Disorders ◽  
European Guidelines ◽  
Obstructive Sleep ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

Obstructive sleep-disordered breathing (SDB) is a common clinical problem. An unrecognized and untreated SDB is a serious threat for an intensively developing organism of a child. The consequences of SDB include cardiovascular and neurological complications, growth disorders and enuresis. Therefore, SDB in children becomes an important subject of many scientific investigations, publications, and congresses. In 2015 the European Respiratory Society Task Force published a document concerning the conclusions about the diagnostics and treatment of SDB in children and youth from 2 to 18 years of age (Fig. 1). The scientific data from 362 publications were presented in a condensed form of “seven steps”, very useful in diagnosing and treatment planning (1). The authors underline the limited number of reliable evidence about SDB: prospective studies, randomized double-blinded studies with placebo. The presented evidence was categorized depending on their quality according to the classification of the American Academy of Neurology (ANN) into classes I – IV. Previously, in 2012, the guidelines of the American Academy of Pediatrics on obstructive sleep apnea syndrome (OSAS) in children with tonsillar hypertrophy and/or obesity were published (2, 3) and they were a valuable diagnostic and therapeutic compendium. The European guidelines discussed in this article result from the progress of knowledge in recent years, they cover the subject broadly, consider rare and difficult cases and present the spectrum of potential therapeutic actions. The aim of the guidelines is a better recognition of SDB, a systematization of diagnosis and treatment at every stage of medical care, including the causes of this disorder and its complications.

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