Abstract
Obstructive sleep apnoea is characterised by repetitive interruptions of breathing during sleep due to upper airway collapse. It affects sleep quality, daytime alertness and quality of life. It is associated with increased cardiovascular morbidity and mortality and an increased risk of road traffic accidents. Sleep apnoea is common among older people and its effects can be more severe than in younger people. The added impact is because of a physiological decline in sleep quality with age in most people and the increasing frequency of other comorbidities with increasing years that affect both sleep and daytime function. It is important to be alert to the diagnosis, bearing in mind these other influences on sleep quality. The diagnosis is generally straightforward once appropriate tests are performed. Treatment is aimed at minimising upper airway obstruction during sleep and the most effective therapy is continuous positive airway pressure. Weight loss can also be effective. Other management options, including surgery, mandibular advancement devices and drug treatment, are less effective, but there are interesting advances in the understanding of the pharmacology of the upper airway. Specific serotonergic agonists hold the greatest potential for a useful drug treatment for this widespread and debilitating condition.
Similar content being viewed by others
References
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnoea. Am J Respir Crit Care Med 2002; 165: 1217–39
George CFP. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax 2001; 56: 508–12
Findley LJ, Unverzagt ME, Suratt PM. Automobile accidents involving patients with obstructive sleep apnoea. Am Rev Respir Dis 1988; 138: 337–40
Ancoli-Israel S, Kripke DF, Klauber MR, et al. Sleep-disordered breathing in community-dwelling elderly. Sleep 1991; 14(6): 486–95
Somers VK, Dyken ME, Clary MP, et al. Sympathetic neural mechanisms in obstructive sleep apnoea. J Clin Invest 1995; 96(4): 1897–904
Morgan BJ, Dempsey JA, Pegelow DF, et al. Blood pressure perturbations caused by subclinical sleep-disordered breathing. Sleep 1998; 21(7): 737–46
Narkiewicz K, Somers VK. The sympathetic nervous system and obstructive sleep apnoea: implications for hypertension. J Hypertens 1997; 15: 1613–9
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22: 667–89
Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 2002; 359: 204–10
Faccenda JF, Mackay TW, Boon NA, et al. Randomised placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnoea-hypopnoea syndrome. Am J Respir Crit Care Med 2001; 163: 344–8
He J, Kryger MH, Zorick FJ, et al. Mortality and apnoea index in obstructive sleep apnoea: experience in 385 male patients. Chest 1988; 94: 9–14
Lacasse Y, Godbout C, Series F. Health-related quality of life in obstructive sleep apnoea. Eur Respir J 2002; 19: 499–503
Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–5
Kim HC, Young T, Matthews CG, et al. Sleep-disordered breathing and neuropsychological deficits. Am J Respir Crit Care Med 1997; 156: 1813–9
Hume KI, Van F, Watson A. A field study of age and gender differences in habitual adult sleep. J Sleep Res 1998; 7: 85–94
Feinsilver SH, Hertz G. Sleep in the elderly patient. Clin Chest Med 1993; 14: 405–11
Findley LJ, Fabrizio MJ, Knight H, et al. Driving simulator performance in patients with sleep apnoea. Am Rev Respir Dis 1989; 140: 529–30
Austroads. Sleep disorders. In: Austroads, editor. Assessing fitness to drive: guidelines and standards for health professionals in Australia. 3rd ed. Sydney: Austroads Inc., 2003: 87–91
Driver and Vehicle Licensing Agency. Renal and respiratory disorders: at a glance booklet [online]. Available from URL: http://www.dvla.gov.uk/at_a_glance/ch7_renal_respiratory.htm [Accessed 2004 Feb 1]
Pankow W, Nabe B, Lies A, et al. Influence of sleep apnoea on 24-hour blood pressure. Chest 1997; 112(5): 1253–8
Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163: 19–25
Lavie P, Herer P, Segev T, et al. Cardiovascular mortality in sleep laboratory patients: excess risk associated with breathing disorders in sleep [abstract]. Sleep 2003; 26 Suppl.: A213
Ancoli-Israel S, Klauber MR, Kripke DF, et al. Sleep apnoea in female patients in a nursing home. Chest 1989; 96: 1054–8
Ancoli-Israel S, Kripke DF, Klauber MR, et al. Morbidity, mortality and sleep-disordered breathing in community dwelling elderly. Sleep 1996; 19: 275–6
Piper AJ, Sullivan CE. Effects of short-term NIPPV in the treatment of patients with severe obstructive sleep apnea and hypercapnia. Chest 1994; 105: 434–40.
Hattori H, Hattori C, Yonekura A, et al. Two cases of sleep apnoea syndrome caused by primary hypothyroidism. Acta Otolaryngol Suppl 2003; 550: 59–64
Hart TB, Radow SK, Blackard WG, et al. Sleep apnoea in active acromegaly. Arch Intern Med 1985; 145: 865–6
Bixler EO, Vgontzas AN, Ten Have T, et al. Effects of age on sleep apnoea in men. Am J Respir Crit Care Med 1998; 157: 144–8
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: 893–900
Elia M. Obesity in the elderly. Obes Res 2001; 9(4 Suppl.): 244–8S
Duran J, Esnaola S, Rubio R, et al. Obstructive sleep apnoea-hypopnoea and related clinical features in a population-based sample of subjects aged 30 to 70 years. Am J Respir Crit Care Med 2001; 163: 685–9
Liu PY, Yee B, Wishart SM, et al. The short-term effects of high-dose testosterone on sleep, breathing, and function in older men. J Clin Endocrinol Metab 2003; 88: 3605–13
Dexter DD, Dovre EJ. Obstructive sleep apnoea due to endogenous testosterone production in a woman. Mayo Clin Proc 1998; 73: 246–8
Zhou XS, Rowley JA, Demirovic F, et al. Effect of testosterone on the apneic threshold in women during NREM sleep [abstract]. J Appl Physiol 2003 Jan; 94(1): 101–7
McConnell AK, Copestake AJ. Maximum static respiratory pressures in healthy elderly men and women: issues of reproducibility and interpretation. Respiration 1999; 66: 251–8
Grunstein R, Wilcox I, Yang T-S, et al. Snoring and sleep apnoea in men: association with central obesity and hypertension. Int J Obes 1993; 17: 533–40
Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991; 46: 85–90
Flemons WW, Whitelaw WA, Brant R, et al. Likelihood ratios for a sleep apnoea clinical prediction rule. Am J Respir Crit Care Med 1994, 85
Stradling JR. Obstructive sleep apnoea: definitions, epidemiology, and natural history. Thorax 1995; 50: 683–9
Strohl KP, Redline S. Recognition of obstructive sleep apnoea. Am J Respir Crit Care Med 1996; 154: 279–89
Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleepdisordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001; 163: 608–13
Ayala C, Cozar MV, Rodriguez JR, et al. Subclinical thyroid disease in institutionalised healthy geriatric population [in Spanish]. Med Clin (Barc) 2001; 117: 534–5
Skjodt NM, Atkar R, Easton PA. Screening for hypothyroidism in sleep apnoea. Am J Respir Crit Care Med 1999; 160: 732–5
Mezon BJ, West P, MaClean JP, et al. Sleep apnoea in acromegaly. Am J Med 1980; 69: 615–8
Perks WH, Horrocks PM, Cooper RA, et al. Sleep apnoea in acromegaly. BMJ 1980; 280: 894–7
Issa FG, Sullivan CE. Alcohol, snoring and sleep apnoea. J Neurol Neurosurg Psychiatry 1982; 45: 353–9
Scanlan MF, Roebuck T, Little PJ, et al. Effect of moderate alcohol upon obstructive sleep apnoea. Eur Respir J 2000; 16: 909–13
Teschler H, Berthon-Jones M, Wessendorf T, et al. Influence of moderate alcohol consumption on obstructive sleep apnoea with and without autoset nasal CPAP therapy. Eur Respir J 1996; 9: 2371–7
Robinson RW, White DP, Zwillich CW. Moderate alcohol ingestion increases upper airway resistance in normal subjects. Am Rev Respir Dis 1985; 132: 1238–41
Office of Population Censuses and Surveys. Health survey for England 1993. London: Her Majesty’s Stationery Office, 1995
Barrick C, Connors GJ. Relapse prevention and maintaining abstinence in older adults with alcohol-use disorders. Drugs Aging 2002; 19: 583–94
Raiha I, Seppala M, Impivaara O, et al. Chronic illness and subjective quality of sleep in the elderly. Aging (Milano) 1994; 6: 91–6
Asplund R. Sleep disorders in the elderly. Drugs Aging 1999; 14: 91–103
Meguro K, Ueda M, Kobayashi I, et al. Sleep disturbance in elderly patients with cognitive impairment, decreased daily activity and periventricular white matter lesions. Sleep 1995; 18: 109–14
Foley DJ, Monjan AA, Masaki KH, et al. Associations of symptoms of sleep apnoea with cardiovascular disease, cognitive impairment, and mortality among older Japanese-American men. J Am Geriatr Soc 1999; 47: 524–8
Ancoli-Israel S, Klauber MR, Butters N, et al. Dementia in institutionalised elderly: relation to sleep apnoea. J Am Geriatr Soc 1991; 39: 258–63
Strollo PJ, Rogers RM. Obstructive sleep apnoea. N Engl J Med 1996; 334: 99–104
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14: 540–5
Friedman M, Tanveri H, La Rosa M, et al. Clinical predictors of obstructive sleep apnoea. Laryngoscope 1999; 109: 1901–7
Stradling JR. Polysomnography versus simpler alternatives. In: Stradling JR, editor. Handbook of sleep-related breathing disorders. Oxford: Oxford University Press, 1993: 105–11
Chiner E, Signes-Costa J, Arriero JM, et al. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax 1999; 54: 968–71
Vazquez J-C, Tsai WH, Flemons WW, et al. Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea. Thorax 2000; 55: 302–7
Ross SD, Sheinhait IA, KJ Harrison, et al. Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnoea. Sleep 2000; 23: 519–32
Management of obstructive sleep apnoea/hypopnoea syndrome in adults. Scottish intercollegiate guidelines network 2003 [online]. Available from URL: http://www.sign.ac.uk [Accessed 2004 Feb 1]
Douglas NJ, Thomas S, Jan MA. Clinical value of polysomnography. Lancet 1992; 339: 347–50
Ayappa I, Norman RG, Krieger AC, et al. Non-invasive detection of respiratory effort-related arousals by a nasal cannula/pressure transducer system. Sleep 2000; 23: 763–71
Hosselet JJ, Norman RG, Ayappa I, et al. Detection of flow limitation with a nasal cannula/pressure transducer system. Am J Respir Crit Care Med 1998; 157: 1461–7
Rubinstein I, Colapinto N, Rotstein LE, et al. Improvement in upper airway function after weight loss in patients with obstructive sleep apnoea. Am Rev Respir Dis 1988; 138(5): 1192–5
Sampol G, Munoz X, Sagales MT, et al. Long-term efficacy of dietary weight loss in sleep apnoea/hypopnoea syndrome. Eur Respir J 1998; 12: 1156–9
National Institute for Clinical Excellence. Guidance on the use of orlistat for the treatment of obesity in adults. Technology Appraisal Guidance No. 22 [online]. Available from URL: http://www.nice.org.uk/docref.asp?.d=15731 [Accessed 2004 Feb 1]
National Institute for Clinical Excellence. Guidance on the use of sibutramine for the treatment of obesity in adults. Technology Appraisal Guidance No. 31 [online] Available from URL: http://www.nice.org.uk/docref.asp?.d=23795 [Accessed 2004 Feb 1]
Bray GA. Drug treatment of obesity. Rev Endocr Metab Disord 2001; 2: 403–18
National Institute for Clinical Excellence. Appraisal consultation document: surgery for people with morbid obesity [online]. Available from URL: http://www.nice.org.uk/article.asp?.a=28700 [Accessed 2004 Feb 1]
Hoijer U, Hedner J, Ejnell H, et al. Nitrazepam in patients with sleep apnoea: a double-blind placebo-controlled study. Eur Respir J 1994; 7: 2011–5
Jokic R, Klimaszewski A, Crossley M, et al. Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnoea syndrome. Chest 1999; 115: 771–81
Sullivan CE, Issa FG, Berthon-Jones M, et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; I(8225): 862–5
Jenkinson C, Davies RJ, Mullins R, et al. Long-term benefits in self-reported health status of nasal continuous positive airway pressure therapy for obstructive sleep apnoea. QJM 2001; 94: 95–9
McFadyen TA, Espie CA, McArdle N, et al. Controlled, prospective trial of psychosocial function before and after continuous positive airway pressure therapy. Eur Respir J 2001; 18: 996–1002
McArdle N, Kingshott R, Engleman HM, et al. Partners of patients with sleep apnoea/hypopnoea syndrome: effect of CPAP treatment on sleep quality and quality of life. Thorax 2001; 56: 513–8
Kribbs NB, Pack AI, Kline LR, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnoea. Am Rev Respir Dis 1993; 147: 887–95
Pepin JL, Krieger J, Rodenstein D, et al. Effective compliance during the first 3 months of continuous positive airway pressure: a European prospective study of 121 patients. Am J Respir Crit Care Med 1999; 160: 1124–9
Chmelik F, Doughty A. Objective measures of compliance in asthma treatment. Ann Allergy 1994; 73: 527–32
Evangelista L, Doering LV, Dracup K, et al. Compliance behaviors of elderly patients with advanced heart failure. J Cardiovasc Nurs 2003; 18: 197–206
Lee AS, Yen KT, Kaplan J. Compliance of nasal continuous positive airway pressure in elderly patients with obstructive sleep apnoea: a retrospective analysis [abstract]. Chest 2000; 118(4 Suppl.): 79S
Hoy CJ, Vennelle M, Kingshott RN, et al. Can intensive support improve continuous positive airway pressure use in patients with the sleep apnoea/hypopnoea syndrome? Am J Respir Crit Care Med 1999; 159: 1096–100
Aloia MS, Di Dio L, Ilniczky N, et al. Improving compliance with nasal CPAP and vigilance in older adults with OSAHS. Sleep Breath 2001; 5: 13–21
Wright J, White J. Continuous positive airway pressure for obstructive sleep apnoea (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 1999
Ferguson KA, Ono T, Lowe AA, et al. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax 1997; 52: 362–8
Snoring children, sleep apnoea and tonsillectomy. Drug Ther Bull 1992; 30: 6–7
Janson C, Gislason T, Bengtsson H, et al. Long-term follow-up of patients with obstructive sleep apnoea treated with uvulopalatopharyngoplasty. Arch Otolaryngol Head Neck Surg 1997; 123: 257–62
Doghramji K, Jabourian ZH, Pilla M, et al. Predictors of outcome for uvulopalatopharyngoplasty. Laryngoscope 1995; 105: 311–4
Larsson LH, Carlsson-Nordlander B, Svanborg E. Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnoea syndrome. Laryngoscope 1994; 104: 1362–8
Hanzel DA, Praia NG, Hudgel DW. Response of obstructive sleep apnoea to fluoxetine and protriptyline. Chest 1991; 100: 416–21
Brownell L, West P, Sweatmen P, et al. Protriptyline in obstructive sleep apnoea: a double blind trial. N Engl J Med 1982; 307: 1037–42
Stepanski E, Conway W, Young D, et al. A double-blind trial of protriptyline in the treatment of sleep apnoea syndrome. Henry Ford Hosp Med J 1988; 36(1): 5–8
Whyte K, Gould G, Airlie A, et al. Role of protriptyline and acetazolamide in the sleep apnoea/hypopnoea syndrome. Sleep 1988; 11: 463–72
Smith I, Lasserson T, Wright J. Drug treatments for obstructive sleep apnoea (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Update Software, 2003
Wilson SJ, Bailey JE, Alford C, et al. Effects of 5 weeks of administration of fluoxetine and dothiepin in normal volunteers on sleep, daytime sedation, psychomotor performance and mood. J Psychopharmacol 2002; 16: 321–31
Gentili A, Godschalk MF, Gheorghiu D, et al. Effect of clonidine and yohimbine on sleep in healthy men: a double-blind, randomised, controlled trial. Eur J Clin Pharmacol 1996; 50: 463–5
Issa F. Effect of clonidine in obstructive sleep apnoea. Am Rev Respir Dis 1992; 145: 465–9
Joint Formulary Committee. Centrally acting antihypertensive drugs. In: Metha DK, executive editor. British National Formulary. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2003: 86–7
White DP, Zwillich CW, Pickett CK, et al. Central sleep apnoea: improvement with acetazolamide therapy. Arch Intern Med 1982; 142: 1816–9
Tojima H, Kunitomo F, Kimura H, et al. Effects of acetazolamide in patients with the sleep apnoea syndrome. Thorax 1988; 43: 113–9
Cook W, Benich J, Wooten S. Indices of severity of obstructive sleep apnoea syndrome do not change during medroxypro-gesterone acetate therapy. Chest 1989; 96: 262–6
Mulloy E, McNicholas WT. Theophylline in obstructive sleep apnoea. Chest 1992; 101: 753–7
Jelev A, Sood S, Liu H, et al. Microdialysis perfusion of 5-HT into hypoglossal motor nucleus differentially modulates genioglossus activity across natural sleep-wake states in rats. J Physiol 2001; 532: 467–81
Horner RL. The neuropharmacology of upper airway motor control in the awake and asleep states: implications for obstructive sleep apnoea. Respir Res 2001; 2: 286–94
Ishizuka T, Sakamoto Y, Sakurai T, et al. Modafinil increases histamine release in the anterior hypothalamus of rats. Neurosci Lett 2003; 339: 143–6
Pack AI, Black JE, Schwartz JRL, et al. Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnoea. Am J Respir Crit Care Med 2001; 164: 1675–81
Acknowledgements
Dr Smith has received travel funds and honoraria for speaking at meetings sponsored by Cephalon, UK.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Quinnell, T.G., Smith, I.E. Obstructive Sleep Apnoea in the Elderly. Drugs Aging 21, 307–322 (2004). https://doi.org/10.2165/00002512-200421050-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002512-200421050-00003