Recognition and Diagnosis of Obstructive Sleep Apnea in Older Americans

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 66; no. 7; pp. 1296 - 1302
• Main Authors: Braley, Tiffany J., Dunietz, Galit Levi, Chervin, Ronald D., Lisabeth, Lynda D., Skolarus, Lesli E., Burke, James F.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2018
• Subjects: Aged; Aged, 80 and over; Aging; Apnea; Cross-Sectional Studies; Diagnosis; Female; Health Status; Humans; Male; Mass Screening - statistics & numerical data; Medical diagnosis; Medicare; National Health and Aging Trends Study; obstructive sleep apnea; polysomnography; Polysomnography - statistics & numerical data; Public health; Respiratory tract; Risk Factors; Severity of Illness Index; Sleep; Sleep apnea; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - epidemiology; Sleep disorders; STOP‐BANG; United States; United States; obstructive sleep apnea; STOP-BANG; polysomnography; Medicare; National Health and Aging Trends Study
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.15372

Objectives
To estimate the proportion of older Americans at risk for obstructive sleep apnea (OSA) who receive OSA evaluations, diagnosis, and treatment.
Design
Cross sectional study.
Setting
National Health and Aging Trends Study (NHATS), Round 3 survey.
Participants
Community‐dwelling Medicare beneficiaries age 65 and older (N=1,052).
Measurements
NHATS participants were asked specific questions about sleep disturbances, including items that resembled critical elements of a validated instrument used to assess OSA risk (the STOP‐Bang questionnaire). The proportion of older Americans at risk for OSA who received evaluations with home or in‐laboratory sleep studies, OSA diagnosis, and OSA treatment was examined, as well as clinical, social, and demographic correlates of OSA.
Results
Of 1,052 participants who completed the sleep module, 56% (95% confidence interval (CI)=53–59%) were estimated to be at high risk of OSA. Only 8% (95% CI=5–11%) of the high‐risk individuals had been tested for it. Of those tested, 94% (95% CI=87–100%) were diagnosed with OSA. Treatment with positive airway pressure was prescribed for 82% (95% CI=65–99%) of participants with an OSA diagnosis.
Conclusions
Evidence from this nationally representative sample of community‐dwelling Medicare beneficiaries suggests that high OSA risk is common but seldom investigated. When investigated, OSA is almost always confirmed and usually treated. These findings suggest a significant gap in OSA assessment for older Americans that could have public health implications.