Morbidity and Predicted Mortality in Older Adults with Central Sleep Apnea

Objectives: To assess cardiovascular morbidity and prognostic mortality risk in older patients with CSA in comparison to those with OSA and without any SDB (apnea-hypopnea index <15/hour). Background: Sleep-Disordered Breathing (SDB), including both Central Sleep Apnea (CSA) and Obstructive Sleep Apnea (OSA), is a prevalent condition in older adults. In contrast to OSA, the information concerning the morbidity and mortality associated with CSA is scarce and inconsistent. Methods: We analyzed a prospectively collected database of consecutive patients aged 70 and over referred for suspicion of SDB. All patients underwent an overnight polysomnography and a clinical assessment. Cardiovascular morbidities and prognostic index for 4-year mortality (PIM) were abstracted from patient records. Results: The data derived from 207 patients (79.7 ± 5.7 years) was divided into three groups according to the apnea classification (20 CSA, 121 OSA, and 66 no-SDB). Stroke (7/20, p= 0.02) and hypertension (19/20, p=0.003) were more frequent in CSA patients than OSA and no-SDB patients. The mean PIM score of patients with CSA (10.7 ± 3.3) was higher than those with OSA (7.8 ± 3.1) and no-SDB (8.4 ± 2.9), even after adjustment for potential confounders including gender and SpO2 (p <0.001). Conclusion: CSA is associated with stroke and hypertension and an increased prognostic mortality risk compared to OSA and no-SDB in older patients. The knowledge of morbidities and mortality risk associated with CSA may help in planning preventive and therapeutic strategies to improve patients’ global health status and quality of life.