Sleep apnoea in older people

Educational Aims To provide a comprehensive, up-to-date review of the prevalence of obstructive sleep apnoea in older people To describe the mechanisms of central and obstructive sleep apnoea in older people To outline the symptoms of sleep apnoea in older people To discuss the evidence base for the treatment of obstructive sleep apnoea syndrome in older people. Summary Obstructive sleep apnoea is a common disorder in older people, with between 13 and 32% of people over 65 yrs old having some sleep apnoea. The variation in the estimated prevalence is likely to reflect the different health status of the older populations studied and the definitions of the disease. This review will address the prevalence and aetiology of sleep apnoea in older people; outlining the possible consequences and treatment options. Age-related changes in chemosensitivity, and sleep architecture may promote central sleep apnoea in older people; while obstructive sleep apnoea is likely to be the result of increased collapsibility of the upper airway; possibly due to changes in upper airway anatomy and muscle function. The consequences of sleep apnoea in older people are unclear, since both sleep apnoea and aging reduce sleep quality and cognitive function. Moreover, there may be a survival advantage of mild sleep apnoea on the cardiovascular system in older people. Therefore the therapeutic advantages of continuous positive airway pressure in older people require further investigation. If future studies demonstrate that continuous positive airway pressure therapy produces a therapeutic benefit in older people this could result improvements in care.