Poster Presentations: Wednesday, October 26, 2011 |

Changes in the Regulation of Breathing in Advanced Aged Adults 75 Years or Older FREE TO VIEW

Richard Bogan, MD; Jo Anne Turner, MN
Author and Funding Information

SleepMed, Inc., Columbia, SC

Chest. 2011;140(4_MeetingAbstracts):803A. doi:10.1378/chest.1112113
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PURPOSE: In a group of advanced age patients =>75 years presenting for sleep evaluation with PSG, prevalence of sleep induced alveolar hypoventilation (AH) and obstructive apnea (OSA) are examined and the degree of sleepiness reported.

METHODS: 42513 baseline PSGs from 2009-2010 at SleepMed were reviewed. ESS was administered before PSG. Two groups of sleep disordered breathing (SDB) were compared. AH group included RDI <10, nadir O2 < 85%, ODI <10, time below 90% = > 10 minutes. Obstructive apnea group (OSA) included RDI >15 without regard to ODI. Oxygen desaturation index (ODI) was measured at => greater than 4%.

RESULTS: Of 22151 men studied 1456(7%) were =>75 years. Of 1456 men, 1042 (72%) were identified to have SDB (AH+OSA=SDB). Of 21362 women studied 1484 (7%) were =>75. Of 1484 women, 865 (58%) were identified to have SDB. As a group of the 2940 there were 1907 total (65%) with SDB. AH group accounted for 163/2940 (6%) of advanced elderly studied and 163/1907 SDB (9%). Men (n=52, 32%) with AH were characterized by a mean age of 79(3); BMI 30(5); ESS 8(5); RDI 7(2); nadir O2 sat 82(3); time<90% minutes 97(94); ODI 4(2). Women (n=111, 68%) with AH were characterized by a mean age of 79(4); BMI 30(7); ESS 8(5); RDI 6(3); nadir O2 sat 81(4); time<90% minutes 98(93); ODI 4(2). AH/SDB= 5% in men and 13% in women. OSA accounted for 1744/2940 (59%) of total studied and 1744/1907 SDB (91%). Men (n=990, 57%) with OSA were characterized by a mean age of 80(4), BMI 29(15); ESS 9.7(5); RDI 40(20); nadir O2 sat 81(7); time < 90% minutes 41(61); ODI 24(18). Women with OSA (n=754, 43%) were characterized by a mean age of 80(4); BMI 31(7); ESS 8.6(5); RDI 36(20); nadir O2 sat 80(8); time<90% minutes 52(69); ODI 21(18). OSA/SDB = 95% in men and 87% in women.

CONCLUSIONS: In SDB, the proportion of patients with low RDI and nocturnal hypoxemia is higher in the advanced aged population group compared to a younger population (previously reported). 65% of advanced age elderly presenting for PSG had clinically relevant SDB. 6% of advanced elderly studied by PSG met criteria for sleep induced hypoxemia. This represented 9% of SDB group. Women had a disproportionately higher prevalence of AH (13% vs. 5%). Mean ESS scores were < 10. These results suggest dysregulation of breathing as manifest by hypoxemia with low RDIs increases with age. Co-morbid illnesses affecting gas exchange may be an alternate explanation.

CLINICAL IMPLICATIONS: In advanced age there is possibly a reduction in respiratory drive augmented by the sleep state.

DISCLOSURE: Richard Bogan: Shareholder: SleepMed, inc, Consultant fee, speaker bureau, advisory committee, etc.: Speaker Bureau: for Jazz, Cepahlon, and Sunovion, Consultant fee, speaker bureau, advisory committee, etc.: Consultant: Jazz, Cephalon, UCB, GSK, Apnicure

Jo Anne Turner: Consultant fee, speaker bureau, advisory committee, etc.: Speaker Bureau: Cephalon, Somaxson, Sunovion, Pfizer

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