Polysomnographic findings in individuals over 50 years of age lacking subjective signs of sleep disturbanc

Czech version

Authors: S. Dostálová ¹; M. Šusta ²; J. Nepožitek ¹; P. Peřinová ¹; I. Příhodová ¹; V. Ibarburu Lorenzo Y Losada ¹; I. Dall`antonia ¹; O. Bezdíček ¹; T. Nikolai ¹; K. Šonka ¹
Authors‘ workplace: Neurologická klinika a Centrum klinických neurověd, 1. LF UK a VFN v Praze ¹; Vysoká škola zdravotnictví a sociální práce sv. Alžběty v Bratislavě, Slovensko ²
Published in: Cesk Slov Neurol N 2020; 83(1): 57-63
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn202057

Overview

Aim: The aim of this study was to investigate sleep in subjects over 50 years of age without subjective sleep complaints using polysomnography.

Patients and methods: This investigation included 42 patients (35 men, median age 64.6 ± 7.5 years) lacking sleep pathologies according to their patient history. The study subjects underwent polysomnography, laboratory tests, neurophysiological tests, brain imaging, neurological examination and sleep questionnaires.

Results: Patient age was shown to be negatively correlated with sleep efficiency (r = –0.356; P = 0.021). Comparing 3 age categories within this cohort (50–59, 60–69, ≥ 70 years), total sleep time (355.6 ± 60 vs. 315.9 ± 88.6 vs. 290.2 ± 53.6 min; P = 0.014) and the percentage of REM (rapid eye movement) sleep (18.3 ± 7.4 vs. 14.1 ± 6.3 vs. 12.9 ± 4.7%; P = 0.020) decreased with age, while percentage of wakefulness (18.7 ± 12.2 vs. 27.9 ± 17.1 vs. 31.3 ± 10%; P = 0.019), the total arousal index (16.9 ± 7.3 vs. 18.4 ± 11.9 vs. 24.5 ± 7.3; P = 0.050) and the periodic limb movement index (6.4 ± 12.2 vs. 11.6 ± 21.1 vs. 37.6 ± 30.5; P = 0.002) increased with age. Furthermore, we diagnosed a high (50%) prevalence of moderate and severe obstructive sleep apnea. The objectively suboptimal sleep parameters did not correspond to the subjective evaluation of patients.

Conclusion: In the over 50-age category, despite a lack of subjective sleep complaints, we found a high prevalence of obstructive sleep apnea and reduced quantity and quality of sleep.

Keywords:

obstructive sleep apnea – polysomnography – older adults – sleep architecture – sleep efficiency – sleep disorders

Sources

1. Johansson P, Alehagen U, Svanborg E et al. Sleep disordered breathing in an elderly community-living population: relationship to cardiac function, insomnia symptoms and daytime sleepiness. Sleep Med 2009; 10(9): 1005–1011. doi: 10.1016/ j.sleep.2009.01.011.

2. Morrell MJ, Finn L, McMillan A et al. The impact of ageing and sex on the association between sleepiness and sleep disordered breathing. Eur Respir J 2012; 40(2): 386–393. doi: 10.1183/ 09031936.00177411.

3. Bixler EO, Vgontzas AN, Ten HT et al. Effects of age on sleep apnea in men: I. prevalence and severity. Am J Respir Crit Care Med 1998; 157(1): 144–148. doi: 10.1164/ ajrccm.157.1.9706079.

4. Mitterling T, Högl B, Schönwald SV et al. Sleep and respiration in 100 healthy caucasian sleepers – a polysomnographic study according to American Academy of Sleep Medicine standards. Sleep 2015; 38(6): 867–875. doi: 10.5665/ sleep.4730.

5. Peppard PE, Young T, Palta M et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342(19): 1378–1384. doi: 10.1056/ NEJM200005113421901.

6. Marin JM, Carrizo SJ, Vicente E et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365(9464): 1046–1053. doi: 10.1016/ S0140-6736(05)71141-7.

7. Kopecek M, Stepankova H, Lukavsky J et al. Montreal cognitive assessment (MoCA): Normative data for old and very old Czech adults. Appl Neuropsychol Adul 2017; 24(1): 23–29. doi: 10.1080/ 23279095.2015.1065261.

8. Bastien CH, Vallieres A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med 2001; 2(4): 297–307. doi: 10.1016/ s1389-9457(00)00065-4.

9. Johns M. Sleepiness in different situations measured by the Epworth sleepiness scale. Sleep 1991; 14(6): 540–545. doi: 10.1093/ sleep/ 14.6.540.

10. American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.2. Darien, IL, USA: AASM 2015.

11. Schenck CH, Mahowald MW. Rapid eye movement sleep parasomnias. Neurol Clin 2005; 23(4): 1107–1126. doi: 10.1016/ j.ncl.2005.06.002.

12. Frauscher B, Iranzo A, Gaig C et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep 2012; 35(6): 835–847. doi: 10.5665/ sleep.1886.

13. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien, IL, USA: AASM 2014.

14. Nepožitek J, Ünalp C, Dostálová S et al. Profil behaviorálních projevů u idiopatické poruchy chování v REM spánku. Cesk Slov Neurol N 2019; 82/ 115(4): 437–441. doi: 10.14735/ amcsnn2019437.

15. Hirshkowitz M, Whiton K, Albert SM et al. National Sleep Foundation‘s updated sleep duration recommendations: final report. Sleep Health 2015; 1(4): 233–243. doi: 10.1016/ j.sleh.2015.10.004.

16. Watson NF, Badr MS, Belenky G et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep 2015; 38(6): 843–844. doi: 10.5665/ sleep.4716.

17. Kryger M, Roth T (eds). Principles and practice of sleep medicine. 6th ed. Philadelphia: Elsevier 2017: 1730.

18. Příhodová I, Dostálová S (eds.) et al. Spánková medicína v kazuistikách. Praha: Mladá Fronta 2016.

19. Ohayon MM, Carskadon MA, Guilleminault C et al. 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(7): 1255–1273. doi: 10.1093/ sleep/ 27.7.1255.

20. Pretl M, Hobzová M, Honnerová M et al. Indikační kritéria pro léčbu porucha dýchání ve spánku pomocí přetlaku v dýchacích cestách u dospělých. Dokument České společnosti pro výzkum spánku a spánkovou medicínu. Neurol praxi 2013; 14(1): 38–41.

21. Heinzer R, Vat S, Marques-Vidal P et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3(4): 310–318. doi: 10.1016/ S2213-2600(15)00043-0.

22. Connolly MJ, Crowley JJ, Charan NB et al. Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax 1992; 47(6): 410–413. doi: 10.1136/ thx.47.6.410.

23. Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005; 28(12): 2948–2961. doi: 10.2337/ diacare.28.12.2948.

24. Alexander KP, Newby LK, Canno CP et al. Acute coronary care in the elderly, part I: non–ST-segment–elevation acute coronary syndromes. Circulation 2007; 115(19): 2549–2569. doi: 10.1161/ CIRCULATIONAHA.107.182615.

25. Vaz Fragoso CA, Van Ness PH, Araujo KL et al. Age--related differences in sleep-wake symptoms of adults undergoing polysomnography. J Am Geriatr Soc 2015; 63(9): 1845–1851. doi: 10.1111/ jgs.13632.

26. Martinez-Garcıa MA, Campos-Rodrıguez F, Catalan-Serra P et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment. Am J Respir Crit Care Med 2012; 186(9): 909–916. doi: 10.1164/ rccm.201203-0448OC.

27. 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(4): 352–360. doi: 10.1161/ CIRCULATIONAHA.109.901801.

28. Haba-Rubio J, Frauscher B, Marques-Vidal P et al. Prevalence and determinants of rapid eye movement sleep behavior disorder in the general population. Sleep 2018; 41(2): pii: zsx197. doi: 10.1093/ sleep/ zsx197.