Sleep apnea and other causes of impaired sleep in older adults
- Steven H Feinsilver, MD
Steven H Feinsilver, MD
- Director, Center for Sleep Medicine
- Professor of Medicine
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
- Nancy Collop, MD
Nancy Collop, MD
- Editor-in-Chief — Sleep Medicine
- Section Editor — Sleep Related Breathing Disorders
- Professor of Medicine and Neurology
- Director, Emory Sleep Center, Emory University
Sleep-related complaints are common among older adults (ie, adults >65 years old). It is often difficult to distinguish whether the impaired sleep that leads to such complaints is a consequence of normal aging or a disease process, such as a primary sleep disorder or a medical illness [1,2]. The causes of impaired sleep in older adults are reviewed here, with a focus on sleep apnea.
THE EFFECTS OF NORMAL AGING ON SLEEP
Sleep-related changes are a normal consequence of aging (table 1):
●Phase advance – Sleep during the early morning hours is reduced and peak sleepiness occurs earlier in the evening [2,3]
●Sleep efficiency – The ratio of time asleep to time in bed declines, largely due to more nocturnal awakenings 
●Sleep time – Total time spent asleep decreases, although the reduction in nocturnal sleep may be partially compensated by increased daytime napping 
- Ayalon L, Liu L, Ancoli-Israel S. Diagnosing and treating sleep disorders in the older adult. Med Clin North Am 2004; 88:737.
- Feinsilver SH, Hertz G. Sleep in the elderly patient. Clin Chest Med 1993; 14:405.
- Haimov I, Lavie P. Circadian characteristics of sleep propensity function in healthy elderly: a comparison with young adults. Sleep 1997; 20:294.
- Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 2004; 27:1255.
- Schnelle JF, Cruise PA, Alessi CA, et al. Sleep hygiene in physically dependent nursing home residents: behavioral and environmental intervention implications. Sleep 1998; 21:515.
- Quan SF, Zee P. Evaluating the effects of medical disorders on sleep in the older patient. Geriatrics 2004; 59:37.
- Hornyak M, Trenkwalder C. Restless legs syndrome and periodic limb movement disorder in the elderly. J Psychosom Res 2004; 56:543.
- Barthlen GM. Sleep disorders. Obstructive sleep apnea syndrome, restless legs syndrome, and insomnia in geriatric patients. Geriatrics 2002; 57:34.
- Jennum P, Riha RL. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. Eur Respir J 2009; 33:907.
- Edwards BA, Wellman A, Sands SA, et al. Obstructive sleep apnea in older adults is a distinctly different physiological phenotype. Sleep 2014; 37:1227.
- Lévy P, Pépin JL, Malauzat D, et al. Is sleep apnea syndrome in the elderly a specific entity? Sleep 1996; 19:S29.
- Hoch CC, Reynolds CF 3rd, Monk TH, et al. Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. Sleep 1990; 13:502.
- Viner S, Szalai JP, Hoffstein V. Are history and physical examination a good screening test for sleep apnea? Ann Intern Med 1991; 115:356.
- Crocker BD, Olson LG, Saunders NA, et al. Estimation of the probability of disturbed breathing during sleep before a sleep study. Am Rev Respir Dis 1990; 142:14.
- Flemons WW, Whitelaw WA, Brant R, Remmers JE. Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med 1994; 150:1279.
- Ancoli-Israel S. Epidemiology of sleep disorders. Clin Geriatr Med 1989; 5:347.
- Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 2002; 162:893.
- Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 2009; 6:e1000132.
- Marshall NS, Wong KK, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008; 31:1079.
- Young T, Palta M, Dempsey J, et al. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ 2009; 108:246.
- Yaffe K, Laffan AM, Harrison SL, et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA 2011; 306:613.
- Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 2010; 122:352.
- Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 2008; 118:1080.
- Redline S, Yenokyan G, Gottlieb DJ, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010; 182:269.
- George CF. Sleep apnea, alertness, and motor vehicle crashes. Am J Respir Crit Care Med 2007; 176:954.
- Munoz R, Duran-Cantolla J, Martínez-Vila E, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 2006; 37:2317.
- Berry DT, Webb WB, Block AJ, et al. Nocturnal hypoxia and neuropsychological variables. J Clin Exp Neuropsychol 1986; 8:229.
- Findley LJ, Barth JT, Powers DC, et al. Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. Chest 1986; 90:686.
- Yesavage J, Bliwise D, Guilleminault C, et al. Preliminary communication: intellectual deficit and sleep-related respiratory disturbance in the elderly. Sleep 1985; 8:30.
- Foley DJ, Masaki K, White L, et al. Sleep-disordered breathing and cognitive impairment in elderly Japanese-American men. Sleep 2003; 26:596.
- Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000; 283:1829.
- Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med 2000; 160:2289.
- Grote L, Ploch T, Heitmann J, et al. Sleep-related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med 1999; 160:1875.
- Dalmases M, Torres M, Márquez-Kisinousky L, et al. Brain tissue hypoxia and oxidative stress induced by obstructive apneas is different in young and aged rats. Sleep 2014; 37:1249.
- McMillan A, Bratton DJ, Faria R, et al. Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial. Lancet Respir Med 2014; 2:804.