Diagnostic challenges of obstructive sleep apnea syndrome: A comparative study between elderly and younger...

Obstructive sleep apnea syndrome (OSAS) in the elderly is common but underdiagnosed pathology due to the accumulated prevalence, atypical symptoms and associated comorbidities. The objective of our study was to determine the clinical and polygraphy characteristics of OSAS in elderly subjects by comparing them to young subjects.

Retrospective and comparative study conducted in the pulmonology department of Charles Nicolle Hospital in Tunis, including 110 patients with OSAS. They were divided into two groups: Group 1 including 55 subjects aged 65 and over, and Group 2 including 55 young subjects aged between 18 and 64 years. Clinical, and polygraphy data were collected.

The mean age of the elderly subjects was 71 ± 4.6 years, on the other hand the mean age of the young subjects was 50 ± 11 years. Predominance of female sex was in both groups, with less smoking among elders and the absence of alcohol consumption. Physical activity was low in both groups but younger patients were more active (p=0.05). Family obesity was more common among young patients. Comorbidities were more present in the elderly subjects predominantly dyslipidemia (AUC=0.66; p=0.003; CI [0.56-0.76]) followed by high blood pressure (AUC=0.65; p=0.005; CI [0.55-0.75]) and diabetes (AUC=0.62; p=0.021; CI [0.52-0.73]). There was no significant difference between the two groups regarding most of the symptoms but nycturia that was mainly observed among older patients (p=0.017). the AUC was high for the NoSAS score indicating a high discriminant value (0.6; CI [0.51-0.70]). But other screening tools such as the STOP-BANG, Pichot and Epworth scales showed no superiority among both groups with a confidence interval respectively [0.42-0.64], [0.39-0.61]and [0.36-0.58]. Analysis of the polygraphy recording of OSAHS did not differ between the 2 groups, nor did the severity of the pathology (p>0.05). Treatment of OSAHS did not differ between the 2 groups (p>0.05). Hygienic dietary rules were prescribed for all patients. Positive pressure ventilation was prescribed in more than a third of cases in the 2 groups, and mandibular advancement orthosis (MAO) in one young patient.

Our study highlights the high prevalence of cardiovascular and metabolic co-morbidities in elderly patients being monitored for OSAHS, in addition to the performance of screening scores in the elderly population especially the NoSAS which justifies the importance of a more targeted early detection in this age group for better management.