Monday, August 07, 2006

Sleep apnea in the elderly

It must be very difficult to diagnose sleep apnea in the elderly. Even in the young, sleep apnea posts a significant diagnostic challenge. Usually, it is a very tired patient during the day (one patient was so bad that he could not keep awake while driving) that makes me suspect the diagnosis of sleep apnea. Eye witness account (the spouse) of apneic episodes, is rare.

When a 70 year old patient complain of lethargy and fatigue during the day (I have heard many such patients complaint) we assume it is normal for this age group. Yet Dr Roberto Munoz and colleagues, in the last issue of Stokes, showed that elderly (>70 years) patients with sleep apnea had a higher episode of strokes.

One must remember that sleep apnea has been shown to be related to hypertension, and even atrial fibrillation. So it is not exactly surprising that sleep apnea is correlated with strokes. However, I must say that I am not aware of sleep apnea being correlated with strokes in the younger population.

As another point, the treatment of sleep apnea in this elderly population also proves a challenge. With younger patients, the use of CPAP devices, has proven very useful. My patients had dramatic improvement in work performance with the use of the CPAP device and was so grateful. Even the spouse was grateful. But, how do you convince the elderly to use the CPAP device? They will feel so suffocated, that they will not use the device. Also, we do not know if elder patients with sleep apnea, when treated with the CPAP device, had the rate of stroke reduced?

This actually forms the basis of another study. When I read this report on sleep apnea in the elderly, I was only very fascinated in the ability to diagnose and pick up for study, elderly patients with sleep apnea. Spanish neurologist and patients are really very good. I must be more observant of my patients and must try to pick up my first case of sleep apnea, is someone over 70years of age. I have yet to do so.

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