PURPOSE: We investigated sleep-disordered breathing (SDB) prevalence in a large cohort of older men based upon Sleep Heart Health Study (SHHS) and American Academy of Sleep Medicine (AASM) criteria, and assessed variation of these SDB indices in relationship to risk factors.
METHODS: Full 12-channel in-home polysomnography (Compumedics, Safiro) was performed in the Outcomes of Sleep Disorders in Older Men Sleep Study (n=2911). Four outcomes were assessed: SDB (respiratory disturbance index (RDI) of ≥15); Sleep Apnea Syndrome (SAS, RDI≥15 and self-reported sleepiness); Obstructive Apnea (OA, obstructive apneas index>5), and Central Apnea (CA, central apnea index≥5). Covariates considered were: age, sex, race, site, body mass index (BMI), hypertension, diabetes mellitus, cardiovascular disease (CVD), alcohol use, and smoking status.
RESULTS: Participants' mean age was 76.38(+/−5.53 [SD]) years, 90.7% were Caucasian, and mean BMI was 27.17(+/− 3.8 kg/m2). The prevalence of SDB was 26.4% (SHHS hypopnea definition) versus 21.4% (AASM definition). Using SHHS criteria, multivariable logistic regression models demonstrated the following significant SDB predictors (odds ratio, 95% confidence interval): age (per year increase) (1.23, 1.13-1.33), BMI (per kg/m2) (1.59, 1.45-1.75), Asians versus Caucasians (2.17, 1.64-4.47), and hypertension (1.22, 1.02-1.46). In addition to these predictors, the following were identified as significant SAS predictors: African Americans versus Caucasians (2.30, 1.11-4.78) and CVD (1.55, 1.06-2.26). OA was associated with age (1.26, 1.16-1.37), BMI (1.21, 1.10-1.32) and alcohol use (1.07, 1.01-1.12). CA was associated with age (1.30, 1.14-1.48) and sleepiness (1.72, 1.10-2.69). Similar results were found when using AASM definitions.
CONCLUSION: Older men have similar SDB risk factors compared to middle-aged adults including age and BMI. Asian and African American older males are at increased odds of SDB compared to their Caucasian counterparts. Alcohol use was a significant predictor of OA and sleepiness was significantly associated with CA in this cohort of older men.
CLINICAL IMPLICATIONS: These analyses suggest similarities in the overall epidemiology of SDB in older compared to middle aged individuals, specifically showing an increased prevalence of SDB with advancing aging and increased obesity in older men.
DISCLOSURE: Reena Mehra, None.