Sleep disordered breathing in the elderly: a three year longitudinal cohort study

The objective of this investigation was to assess the association between the presence of sleep disordered breathing (SDB) and daytime sleepiness, body mass index, hospitalisation, and survival. To this end, a prospective longitudinal study was conducted in the elderly population consisting of 80 patients of either sex over the age of 65 years admitted to a city hospital in Germany without any history of SDB. All patients met the following exclusion criteria: age <65 yr, heart failure, and chronic obstructive lung disease. Baseline anthropometric and cardiorespiratory (one-night portable polygraphic recording) data, and a standardized sleep and sleepiness-questionnaires (Epworth Sleepiness Scale, ESS) were obtained in 1999. A second screening was conducted in 2003. Thirty one women and 34 men completed the follow-up after 3 years. These patients were divided into two subgroups: (i) no clinically relevant SDB and (ii) SDB (apnea-hypopnea index, AHI, >or=5 plus excessive day time sleepiness, ESS, >9). Six men and 3 women fulfilled the criteria of SDB. Thirty three percent of patients with SDB and 20% of patients without SDB died during the follow-up period. Duration of hospital stay was 35 days for the SDB patients and 20 days for patients without it. Body weight and sleepiness did not change significant over the 3-year period between the two cohorts. We conclude that the presence of SDB was associated with a 1.5-fold higher mortality and longer hospital stay in elderly patients over a period of 3 years even in persons without previous history of SDB. Daytime sleepiness was a better predictor than AHI or BMI for death.