Increased Incidence of Stroke, but Not Coronary Heart Disease, in Elderly Patients With Sleep Apnea.

Background and Purpose- The influence of age on the relationship between obstructive sleep apnea (OSA) and the incidence of hard cardiovascular events remains controversial. We sought to analyze the relationship between OSA and the incidence of stroke and coronary heart disease in a large cohort of elderly patients, as well as to investigate the role of continuous positive airway pressure (CPAP) treatment in these associations. Methods- Post hoc analysis of a prospective observational study of consecutive patients ≥65 years studied for OSA suspicion at 2 Spanish University Hospitals. Patients with an apnea-hypopnea index (AHI) <15 were the reference group. OSA was defined by an AHI ≥15 and classified as untreated (CPAP not prescribed or compliance <4 hours/day), mild-moderate (AHI 15-29), untreated severe (AHI ≥30), and CPAP-treated (AHI ≥15 and CPAP compliance ≥4 hours/day). Results- 859 and 794 elderly patients were included in the stroke and coronary heart disease analyses, respectively. The median (interquartile range) follow-up was 72 (50-88.5) and 71 (51.5-89) months, respectively. Compared with the reference group, the fully adjusted hazard ratios for the incidence of stroke were 3.42 (95% CI, 1.37-8.52), 1.02 (95% CI, 0.41-2.56), and 1.76 (95% CI, 0.62-4.97) for the untreated severe OSA group, CPAP-treated group, and untreated mild-moderate OSA group, respectively. No associations were shown between any of the different OSA groups and coronary heart disease incidence. Conclusions- The incidence of stroke, but not coronary heart disease, is increased in elderly patients with untreated severe OSA. Adequate CPAP treatment may reduce this risk.

Impacto del síndrome de apneas-hipopneas durante el sueño en el anciano / Sleep apnea-hypopnea syndrome impact in the elderly. Towards a specific diagnosis and therapeutic approach

La prevalencia y la gravedad del Síndrome de Apneas-Hipopneas durante el sueño (SAHS) aumentan con la edad. A pesar de ello se trata de una enfermedad infradiagnosticada y actualmente no existe un consenso claro sobre cual debe ser el enfoque diagnóstico y terapéutico de los pacientes de edad avanzada. El número de ancianos está aumentando en nuestro país de manera significativa en los últimos años, así como el número de pacientes de edad avanzada remitidos a las Unidades de Sueño para estudio de un posible SAHS, probablemente como consecuencia de una mayor concienciación de las consecuencias negativas sobre la salud de esta enfermedad. Se estima que una cuarta parte de los estudios de sueño se realiza en pacientes mayores de 65 años y de estos a más de la mitad se les prescribe tratamiento con presión positiva continua en la vía aérea (CPAP) sin una evidencia científica clara que lo justifique. A falta de nuevas recomendaciones específicas, las guías vigentes sostienen que la edad no debe ser un factor limitante a la hora de decidir el tratamiento de los pacientes de edad avanzada. Dado el incremento en la longevidad observado en las últimas décadas en nuestro país, el elevado gasto que supone esta patología y las consecuencias sobre la salud en los individuos que la padecen, descubrir cuál es el diagnóstico y tratamiento más apropiado en los pacientes de edad avanzada con SAHS debe ser un objetivo prioritario en la investigación clínica (AU)

The prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) increases with age. Nevertheless it is an underdiagnosed disease and there is currently no clear consensus on which should be the diagnostic and therapeutic approach in the elderly. In the last few years the elderly population is significantly increasing in our country, and the number of elderly patients referred to the Sleep Unit for suspected SAHS is also increasing, probably due to the increased awareness of the negative consequences of this disease on health. It is estimated that a quarter of the sleep studies are performed in patients older than 65 years and in more than a half of them the treatment with continuous positive airway pressure (CPAP) is prescribed with no clear scientific evidence to support it. In the absence of specific recommendations, current guidelines state that age should not be a limiting factor when deciding on the treatment of elderly patients. Considering the increased longevity observed in recent decades in our country, the high economic cost of this pathology and its consequences on health, it should be a priority in clinical research to find out what is the most appropriate diagnosis and treatment in this age froup (AU)