Alexandra Monti1, Mohamed Doulazmi2, Vi-Huong Nguyen-Michel3, Eric Pautas4, Jean Mariani5, Kiyoka Kinugawa6. 1. Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FAST, Polyvalent Geriatric Center, Charles Foix Hospital, Pitié-Salpêtrière-Charles Foix Group, F-94200, Ivry-sur-Seine, France. 2. Sorbonne Université, CNRS, UMR 8256 Biological Adaptation and Aging, F-75005, Paris, France. 3. Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FAST, Functional Explorations and Sleep Investigation Unit for the Older Patients, Charles Foix Hospital, Pitié-Salpêtrière-Charles Foix Group, F-94200, Ivry-sur-Seine, France. 4. Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FAST, Polyvalent Geriatric Center, Charles Foix Hospital, Pitié-Salpêtrière-Charles Foix Group, F-94200, Ivry-sur-Seine, France; Sorbonne Université, UFR Médecine, F-75013, Paris, France. 5. Sorbonne Université, CNRS, UMR 8256 Biological Adaptation and Aging, F-75005, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FAST, Functional Explorations and Sleep Investigation Unit for the Older Patients, Charles Foix Hospital, Pitié-Salpêtrière-Charles Foix Group, F-94200, Ivry-sur-Seine, France; Sorbonne Université, UFR Médecine, F-75013, Paris, France. 6. Sorbonne Université, CNRS, UMR 8256 Biological Adaptation and Aging, F-75005, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), DHU FAST, Functional Explorations and Sleep Investigation Unit for the Older Patients, Charles Foix Hospital, Pitié-Salpêtrière-Charles Foix Group, F-94200, Ivry-sur-Seine, France; Sorbonne Université, UFR Médecine, F-75013, Paris, France. Electronic address: kiyoka.kinugawa@aphp.fr.
Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is prevalent in older adults but still underdiagnosed for many reasons, such as underreported symptoms, non-specific ones because of the comorbidities and polypharmacy, or the social belief of sleep problems as normal with aging. OBJECTIVES: To identify salient symptoms and comorbidities associated with OSA, diagnosed by nocturnal respiratory polygraphy in geriatric inpatients. METHOD: We conducted a retrospective, cross-sectional study in a sample of 102 geriatric inpatients from a French Geriatric University Hospital. We reviewed medical records to collect demographic, medical information including comorbidities, the geriatric cumulative illness rating scale (CIRS-G), subjective sleep-related symptoms and data of overnight level three portable sleep polygraphy recording. RESULTS: Among classic OSA symptoms, only excessive daytime sleepiness (p = 0.02) and nocturnal choking (p = 0.03) were more prevalent in older inpatients with OSA (n = 64) than in those without (n = 38). The prevalence of comorbidities and mean CIRS-G scores were not different between groups except for the lower prevalence of chronic obstructive pulmonary disease and the higher level of creatinine clearance in OSA patients. Multivariate analysis showed OSA was associated with excessive daytime sleepiness (OR = 2.83, p = 0.02) in symptoms-related model and with composite CIRS-G score (OR 1.26, p = 0.04) in comorbidities-related model. CONCLUSIONS: Only excessive daytime sleepiness and comorbidity severity (composite CIRS-G score) were associated with the objective diagnosis of OSA, while other usual clinical OSA symptoms and comorbidities in geriatric inpatients were not. These findings emphasize the importance of excessive daytime sleepiness symptom, when reported in comorbid older patients, strongly suggesting OSA and requiring adequate nocturnal exploration.
BACKGROUND: Obstructive sleep apnea (OSA) is prevalent in older adults but still underdiagnosed for many reasons, such as underreported symptoms, non-specific ones because of the comorbidities and polypharmacy, or the social belief of sleep problems as normal with aging. OBJECTIVES: To identify salient symptoms and comorbidities associated with OSA, diagnosed by nocturnal respiratory polygraphy in geriatric inpatients. METHOD: We conducted a retrospective, cross-sectional study in a sample of 102 geriatric inpatients from a French Geriatric University Hospital. We reviewed medical records to collect demographic, medical information including comorbidities, the geriatric cumulative illness rating scale (CIRS-G), subjective sleep-related symptoms and data of overnight level three portable sleep polygraphy recording. RESULTS: Among classic OSA symptoms, only excessive daytime sleepiness (p = 0.02) and nocturnal choking (p = 0.03) were more prevalent in older inpatients with OSA (n = 64) than in those without (n = 38). The prevalence of comorbidities and mean CIRS-G scores were not different between groups except for the lower prevalence of chronic obstructive pulmonary disease and the higher level of creatinine clearance in OSA patients. Multivariate analysis showed OSA was associated with excessive daytime sleepiness (OR = 2.83, p = 0.02) in symptoms-related model and with composite CIRS-G score (OR 1.26, p = 0.04) in comorbidities-related model. CONCLUSIONS: Only excessive daytime sleepiness and comorbidity severity (composite CIRS-G score) were associated with the objective diagnosis of OSA, while other usual clinical OSA symptoms and comorbidities in geriatric inpatients were not. These findings emphasize the importance of excessive daytime sleepiness symptom, when reported in comorbid older patients, strongly suggesting OSA and requiring adequate nocturnal exploration.