Older Age is Associated With Positional Obstructive Sleep Apnea.

Area of Science:

• Sleep Medicine
• Geriatrics
• Respiratory Medicine

Background:

• Obstructive sleep apnea (OSA) is linked to cognitive issues, but elderly patients show low adherence to continuous positive airway pressure (CPAP).
• Positional OSA (p-OSA) is a subtype manageable with positional therapy, avoiding supine sleep.
• Clear criteria are lacking to identify patients suitable for positional therapy as an alternative or adjunct to CPAP.

Purpose of the Study:

• To investigate the relationship between older age and the prevalence of positional OSA (p-OSA).
• To evaluate different diagnostic criteria for identifying p-OSA in older versus younger adults.
• To determine if older patients are more likely to benefit from positional therapy.

Main Methods:

• A cross-sectional study retrospectively analyzed polysomnography data from adult patients.
• Positional OSA (p-OSA) was defined by supine-dependent breathing events and non-supine apnea-hypopnea index (AHI) < 5/hour.
• Logistic regression compared p-OSA prevalence between older (≥65 years) and propensity score-matched younger (<65 years) adults using various s-AHI/ns-AHI ratios.

Main Results:

• Older adults exhibited a significantly higher supine AHI/non-supine AHI (s-AHI/ns-AHI) ratio compared to younger adults.
• After propensity score matching, older patients showed a higher proportion with severe positional dependency (e.g., s-AHI/ns-AHI ≥ 10, ≥ 15, ≥ 20) and ns-AHI < 5/hour.
• Odds ratios indicated a 2.24 to 2.52 times higher likelihood of severe p-OSA in older individuals.

Conclusions:

• Older patients with OSA are more likely to have severe positional OSA.
• Positional therapy presents a viable alternative or adjunct treatment for elderly OSA patients, especially those with cognitive impairment or CPAP intolerance.
• This study supports considering positional therapy for older adults with OSA, optimizing treatment adherence and outcomes.