OSA in Older Adults: Often Present, Seldom Investigated

Research finds that more than half of Medicare beneficiaries have a high risk of obstructive sleep apnea, but few have been assessed for the sleep disorder.

7:00 AM

Author | Haley Otman

Older Americans are often at a high risk for obstructive sleep apnea, yet this illness remains vastly underdiagnosed, a new study finds.

MORE FROM THE LAB: Subscribe to our weekly newsletter

Michigan Medicine researchers found evidence that more than half (56 percent) of people ages 65 and older have a high risk of OSA, a sleep disorder in which the throat collapses during sleep, causing the patient to repeatedly stop breathing for periods of 10 seconds or longer throughout the night.

But only 8 percent of these individuals have been tested for OSA, a disorder that is associated with significant health risks. An overnight sleep study is necessary to diagnose OSA.

"It appears most older adults who are at risk for obstructive sleep apnea may not be getting referred for overnight sleep studies, and we may be missing an important chance for treatment," says co-first author Tiffany Braley, M.D., M.S., assistant professor of neurology at Michigan Medicine.

'Almost always confirmed'

The data, published in the Journal of the American Geriatrics Society, come from 1,052 Medicare beneficiaries who completed a series of sleep questions and other surveys as part of the National Health and Aging Trends Study (NHATS). The NHATS sample is representative of more than 7 million Americans.

"We see that OSA was rarely evaluated, but when it was, it was almost always confirmed, as nearly all — 94 percent — of those at risk and tested for OSA were diagnosed," says co-first author Galit Levi Dunietz, Ph.D., MPH, postdoctoral research fellow in sleep epidemiology at Michigan Medicine's Sleep Disorders Centers. "This suggests an opportunity to increase the evaluation among older Americans."

The NHATS survey questions about sleep resembled STOP-Bang, a popular questionnaire used in the clinical setting to evaluate common OSA risk factors. The survey evaluated whether respondents were at an advanced age, snored, were overweight, were male, had high blood pressure or felt fatigued.

Among the 94 percent of those who received a diagnosis after being deemed at risk and given a sleep study, 82 percent of respondents' physicians prescribed the first-line treatment. Continuous positive airway pressure, or CPAP, sends pressurized air through the nose, or nose and mouth, to the throat, keeping it from collapsing during sleep.

"It was good to see a high treatment rate after diagnosis, so the main concern is the underdiagnosis of OSA," Dunietz says.

More research needed

"We know that OSA is quite common, yet often underdiagnosed, in adults in the U.S.," Braley says. "But most of the data available are from younger or middle-aged patients."

SEE ALSO: Diagnosing Obstructive Sleep Apnea: New Guidelines Help Doctors Decide

In the young and middle-aged populations, OSA is linked to significant health risks and can worsen quality of life. But in addition to a lack of data on the prevalence of OSA in the older population, Braley says more research is needed to confirm whether the consequences are the same for OSA in older adults.

"This is an important first step in getting to the heart of the question: What is the national scope of OSA, and our ability to recognize it, in all age groups?" she says.

"If we can assume that older adults are subject to the same risks of OSA as middle-aged adults, then missing a diagnosis could ultimately lead to a higher risk of conditions like hypertension, stroke, heart disease, diabetes and depression, as well as cognitive impairment, which is especially important for older individuals. These conditions have serious impact and lead to expensive medical care."

And some older patients may not realize their snoring, sleepiness, tiredness and other symptoms of OSA could be because of something other than normal aging. Those who are already dealing with health conditions such as obesity, diabetes, stroke, a previous heart attack and high blood pressure are more likely to experience OSA as well.

"The results of this study are impressive," says co-author Ronald Chervin, M.D., M.S., professor of neurology and director of the Sleep Disorders Centers at Michigan Medicine. "They amount to estimates, but even so, they help to quantify the magnitude of the challenge.

"We already know that untreated sleep apnea costs billions each year, with decreased work productivity, impaired quality of life and increased medical costs. We still need to learn more about the impact of OSA in older persons more specifically, but the findings of this study suggest a huge, untapped opportunity to improve lives in older years, and perhaps medical costs as well, through more effective diagnosis, and then treatment, of OSA."

The American Sleep Medicine Foundation funded this study. Additional authors included Lynda Lisabeth, Ph.D., MPH; Lesli Skolarus, M.D., M.S.; and James F. Burke, M.D., M.S., all from the University of Michigan.


More Articles About: Lab Report Sleep Apnea Sleep Disorders Testing Geriatrics Sleep Disorders
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories illustration of man sleeping in bed with CPAP machine on
Health Lab
Free sleep clinic addresses disparities in treatment of sleep disorders
New sleep medicine service aims to combat sleep disorders and help reduce poor health outcomes for people without health insurance.
Woman sleeping on a couch holds her stomach, as if in pain
Health Lab
Long COVID-19 is linked to chronic pain conditions
Therapies for pain conditions like fibromyalgia provide clues for helping those with long COVID-19
Minding Memory with a microphone and a shadow of a microphone on a blue background
Minding Memory
The Professional Workforce of People Who Provide Dementia Care
In this episode of Minding Memory, Matt & Donovan speak with Dr. Joanne Spetz, the Brenda and Jeffrey L. Kang Presidential Chair in Healthcare Finance and Director of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco (UCSF). Joanne talks with Matt & Donovan about who makes up the professional workforce of people who provide dementia care and how these individuals play a critical role in the delivery of services. Joanne also discusses how different professional roles interact across setting of care. Lastly, Joanne introduces a new study she is working on with Donovan called the National Dementia Workforce Study (NDWS) that will be surveying a large group of clinicians who provide care for people living with dementia.
Older woman listening to music with headphones as she lays on a couch.
Health Lab
Music may bring health benefits for older adults
Making music by singing or playing an instrument, or listening to music, brings health and wellbeing benefits to many older adults.
Surgeon's tray with gloved hand reaching into wallet
Health Lab
Worries about costs, time off work and COVID-19 kept some older adults from having surgery
Elective surgery study shows older adults have concerns about what it will cost them, how much work they’ll miss and whether they’ll catch COVID-19.
Illustration of physician with prescriptions, indicating online options
Health Lab
Few older adults use direct-to-consumer health services; those who do don’t tell their regular provider
Buying health care services directly online offers convenience but also risks if patients don’t tell their regular doctor or provider. Poll looks at older adults’ use and attitudes.