The Connection Between Sleep Apnea and Health for Seniors
Sleep apnea has been a subject of debate in the world of medical research. It has also been a common link to certain illnesses that people experience as they age. However, is sleep apnea one of the reasons diseases progress? Or is sleep apnea just a risk factor that links to most diseases?
Since sleep apnea can affect people of all ages, diagnosis and treatment are of paramount concern. Studies, tests, and surveys have found evidence of sleep apnea’s prevalence in each age-group, its risk factors, and complications.
Prevalence of Sleep Apnea in Seniors
Sleep apnea is a breathing disorder that occurs during sleep. This prevalence of sleep apnea increases with age. The percentage of people with sleep-disordered breathing (SDB) varies from 20 to 40 percent in the general population, and this percentage increases by age-group until it flattens at around 60 to 65 years (McMillan & Morrell, 2016).
Furthermore, the likelihood of sleep apnea as people age is probably due to physical and physiological changes. However, this disorder affects not only the elderly population but the younger population, as well, in which the incidence rate is double (McMillan & Morrell, 2016).
In the study conducted by Alison McMillan and Mary J. Morrell, the proponents gathered apnea-hypopnea indices (AHI) from different authors. The majority population, who became the subjects of the tests and respondents of the surveys conducted, came from the community. Only a few authors conducted surveys in clinics and nursing homes.
Based on the gathered data, the prevalence of sleep apnea as measured by AHII for older people is high, ranging from 5 to 70 for AHI ⩾ 5 events·h−1 and 4 to 64 for AHI ⩾10 or ⩾ 15 events·h−1 (McMillan & Morrell, 2016).
Aside from that, another study from the American Journal of Respiratory and Critical Care Medicine found that age-specific apnea peaks at 50 to 59 years old among men (Bixler et al., 1998). Another study, published in the Journal of Thoracic Disease, reports that sleep apnea is more common in men than it is in women (Garvey et al., 2015).
The study reports that men and women from ages 30 to 70 have an AHI of 34 percent and 17.4 percent, respectively. Thus, this high occurrence of apnea among seniors has led to more consequences on the elderly and more extensive studies and debates.
Causes and Risk Factors in Older People
Studies about sleep apnea have paved the way for medical science to prevent and treat this disorder. Here are some of the causes of sleep apnea and the reasons seniors are prone to it:
- Sleeping positions. Sleeping on one’s back is a common cause of apnea. It narrows or blocks the airways.
- Hormonal abnormalities. Conditions like hypothyroidism and acromegaly may cause obstructive sleep apnea (OSD) due to the swelling of the airways’ tissues. The swelling may reduce the passage of air or completely block it.
- Cigarette smoking. The dangers of cigarette smoking are so extensive that it can also trigger OSD. Smokers, especially heavy smokers, are exposed to a higher risk of having sleep breathing disorders (SBDs) like sleep apnea.
- Anatomical differences. The jaw’s size, the shape of the mouth, the neck shape, the size of the tongue, and the tonsils can cause sleep apnea. In fact, obesity as fat may build up on organs such as the lungs and restrict contraction when a person is breathing.
Sleep apnea develops symptoms that can be detected through sleep therapies and personal interviews. Here are some of the common symptoms:
- Disrupted breathing during sleep
- A sudden stop in breathing
- Excessive daytime sleepiness
- Headaches in the morning
- Difficulty in thinking and functioning during the day
These symptoms are present in the National Aging and Trends Study questionnaire. In this survey, the respondents are asked to answer the STOP-BANG questions to assess if they have sleep apnea. STOP-BANG stands for “snoring, tiredness, observed pauses in breathing, high blood pressure, BMI, age, neck circumference, and gender” (HealthinAging.org, 2018).
However, it is worth noting that some sleep-related symptoms do not generally equate to sleep apnea. Thus, the following symptoms are only connected to sleep apnea and in no way a sign that a person has this disorder:
- Snoring at night
- Loud snoring that involves gasping, choking, or snorting
- Sore throat or dry mouth in the morning
- Frequent urination at night
But take note also that chronic snoring is a symptom of apnea. Snoring, in general, may be an indication of another breathing disorder, such as sleep apnea or any other illness.
The prevalence of SBD among seniors exposes them to more health risks like cardiovascular diseases and cognitive impairment. As sleep apnea peaks with the age of seniority, being diagnosed with SBDs can further complicate the following health issues:
Experts can see the clear connection between sleep apnea and the risk of developing heart problems like stroke, heart failure, and coronary heart disease in middle-aged populations but cannot see that same connection among the elderly population (McMillan & Morrell, 2016).
In the same study by McMillan and Morrell, they cited a study of Haas et al. (2005) to show the connection between cardiovascular health and arousal during sleep. Haas’s study found that older people with poor cardiovascular health also show an acute response to arousal from sleep more than the younger people do.
In summary, the younger population is more prone to cardiovascular diseases associated with sleep apnea. As for the seniors, untreated SBDs increase their mortality rate due to heart problems (McMillan & Morrell, 2016).
In a 2016 study, McMillan and Morrell observed a link between cerebrovascular problems and SBDs. However, there is no apparent connection if SBD preceded stroke occurrence or if it’s due to other factors, like age, sex, BMI, and diabetes.
According to Arzt’s longitudinal analysis (Arzt et al., 2005), as referenced in the study of McMillan and Morell, the only relationship found is the increased risk of stroke with people who have mild to severe OSD. But still, there is no apparent connection.
Since sleep apnea affects a person’s quality of sleep, experts are looking into its cognitive effects. However, there is no connection made between CBD and cognitive dysfunction. Studies have been performed in this area, but results show that cognitive impairment seems independent of OSD (McMillan & Morrell, 2016).
Complications of Obstructive Sleep Apnea
In a recent study by Andrade et al. (2019), the proponents explored the relationship between OSD, Alzheimer’s disease (AH), and full-blown dementia. Due to the prevalence of OSD in older populations, sleep apnea is commonly linked to cognitive decline.
Due to the sleep fragmentation caused by sleep apnea, some experts believe that it causes cognitive dysfunction. However, the study by Andrade et al. points out that sleep disturbances can cause poor cognitive performance but not dementia. The researchers note that sleep apnea only increases the risks but does not cause the development of AH and dementia.
In conclusion, the proponents stated that OSD could be a risk factor for AH and dementia. But due to the different mechanisms at work, it’s hard to point out if OSD directly contributes to the progression of AH and dementia (Andrade et al., 2019).
- Heart Failure
The study of Khattak et al. (2018) looks into the relationship between heart failure (HF) and OSD. They have found that OSD can substantially progress the development of HF. However, there is no clear-cut evidence on the effect of OSD and HF.
Though the proponents have seen the improved cardiovascular function of patients who underwent CPAP therapy, they cannot conclude any direct involvement of OSD in HF. However, untreated OSD can increase the mortality rate of patients with HF and OSD. In contrast, undergoing CPAP treatment can reduce such health risks.
CPAP Treatment for Seniors
With the lack of clinical studies and conflicting medical opinions, medical experts cannot yet make a definitive conclusion on the benefits of CPAP therapy for seniors (Posadas et al., 2020). But due to the rise of OSD cases in seniors, doctors still prescribe this treatment to seniors.
The studies on the effect of CPAP on seniors are inconclusive due to contradicting literature and the lack of a benchmark AHI that would qualify as pathological. The aging results are also considered, and the complications that come with aging add to the obscuring effect.
Despite that issue, adherence to continuous CPAP treatment yields better results in terms of sleep quality and cognitive ability (Sawyer et al., 2012). Moreover, continued adherence to CPAP produces good results in mental and sexual aspects.
The only viable reason OSD complicates other health illnesses is possibly the lack of adherence. Compliance with CPAP therapy seems to decline, starting from zero to 120 months of undergoing therapy (Posadas et al., 2020). Thus, declining compliance may cause an OSD’s severity and contribute to more health risks, like heart failure and dementia.
Sleep apnea appears to be prevalent in seniors, and the risk of developing SBDs advances with age. Though people in younger age-groups don’t experience illnesses common with the elderly, having SBDs exposes them to more health risks, like cardiovascular and cerebrovascular diseases.
While nothing is conclusive yet, CPAP therapy has shown promising results in people who continue to adhere to the treatment. On the contrary, mortality increased in people who discontinued CPAP therapy. But due to more complex factors, like aging and preexisting medical conditions, medical experts have yet to find conclusions about SBD’s relationship with other health complications.
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