Prevalence of OSA among the Elderly

[roster]

Among the elderly, obstructive sleep apnea (OSA) is present in 24% of people who live independently, 33% of those in acute care institutions, and 42% who are in nursing homes.

http://www.betterlivinghomeimprovement. ... a-devices/

[DoriC]

Rooster, This sounds like an accurate statistic. Our Dr is a Geriatric Specialist and told us that about half his patients have some form of OSA but only 20-25% are on cpap therapy, the others either refuse sleep studies or if diagnosed, refuse treatment.

[roster]

Rooster, This sounds like an accurate statistic. Our Dr is a Geriatric Specialist and told us that about half his patients have some form of OSA but only 20-25% are on cpap therapy, the others either refuse sleep studies or if diagnosed, refuse treatment.

I continue to maintain that more than 50% of our population either has SDB or will develop it.

PBS (pbs.org) did have a comprehensive video on their site in which they claim 30%. They will eventually catch up to my 50%.

If someone can find the PBS-produced video on their site, please post the link.

Thanks.

[Julie]

If that's actually the case (possibly up to 50% or even not as high), then I think, as I have been doing a lot lately, that we really need to look to what it all means on a larger scale. Are we only programmed to live so long, or be healthy so long, but have artificially pushed past the point with technology and don't belong here? Or are there hard-wired processes built in to an almost-majority of us (even the skinny ones that intrinsically make us different physiologically to the other half of the population and should we therefore have a whole other medical system to serve our particular needs? Can we really blame it all on lifestyle (even the babies who are found to have OSA)?

I realize that all might sound a little 'out there', but what is going on?

[roster]

It doesn't sound "out there" to me. I am convinced we need a new treatment because so many are scared of CPAP and will not adopt it and of those that do start CPAP reportedly 55% fail.

Going back to the causes, there are two issues.

1. Maybe the evolutionary process was flawed as we developed a complicated voice box for speech and our voice box is below the tongue and soft palate rather than above it as in many other mammals. This complicates keeping the airway open during sleep. Through that airway we must breathe, speak and eat. Three very different activities through one conduit is a complex design and opens up the possibility of operational problems.

2. Most modern societies have diets that allow the consumption of sufficient calories with very little chewing compared to the amount of vigorous chewing that earlier primitive man had to do to consume enough calories. It takes exercise of the skeleton to make it fully develop. Less chewing during the adolescent years and the jaw is not fully developed. We end up with narrow jaws and poor mandibular advancement. But the tongue and soft palate are as big as ever and restrict air flow though the small skeletal opening. Fewer years of breastfeeding may also play a role in failure of the jaw to develop.

Dr. Steven Parks discusses these issues in his book, Sleep, Interrupted.

So first, we need a new therapy or cure to replace CPAP, dental devices and tracheotomies. Beyond that, we need to figure out how to get jaws to fully develop during our "growing" years.

SDB is a huge problem and has an unrecognized impact on current "health care issues". Solve SDB fully and cheaply and the economics of health care will look very different.

[DoriC]

It doesn't sound "out there" to me. I am convinced we need a new treatment because so many are scared of CPAP and will not adopt it and of those that do start CPAP reportedly 55% fail.

Although I have explained OSA many times and what is involved with cpap therapy, people nod as if understanding but most are still thorougly convinced that Mike can only sleep with an oxygen mask and ask if we have those big tanks in our house. That is scary.

[Scarlet834]

I can well believe our jaw structure has been changing over the years. It is probably for similar reasons that we either are missing wisdom teeth, or if they do come in they don't fit.

[roster]

I can well believe our jaw structure has been changing over the years. It is probably for similar reasons that we either are missing wisdom teeth, or if they do come in they don't fit.

Agreed. If you have crooked teeth or required braces to straighten them or had to have wisdom teeth extracted, it is likely your jaw is narrower than nature intended.

[roster]

Here is a quote from Dr. Steven Park's blog yesterday:

It’s been estimated that 24% of middle aged men and 9% of women have at least mild sleep apnea. This is one of the most often cited statistics from 1993. I would think that with the obesity epidemic, the numbers are now much higher. A recent study looking at active independent seniors (ages 71-87) showed that 55% had significant sleep apnea. These numbers are much higher for seniors that are hospitalized.

http://doctorstevenpark.com/mandatory-s ... r-everyone

BTW, that 55% number Park quotes, support my contention that more than 50% of our population either has sleep apnea or will develop it.

[wearysoul]

My 83-year-old father (who lives independently with my mother) had a sleep study during the spring of this year (before I did) and was diagnosed with OSA. He resisted getting a CPAP until this past week. He used it one night and took it off. Sounds like he's going to send it back to the DME. When I spoke with him on the phone yesterday, he listed a number of reasons why he isn't going to use it: it's too expensive (although he is well able to pay the co-pay), he can't sleep with that thing, he sleeps all right without it (claims he doesn't wake up), etc. Never mind that he has diabetes and sees a pulmonologist for lung issues. Bottom line is that I think fear is at the root of his refusal to use it. I think CPAP fear is a huge issue on a number of levels.

My father has heard me talk about my CPAP difficulties, and although he wouldn't admit this, I think he's afraid he just couldn't make it work. He's uneducated and really doesn't understand the technical jargon. And I think he's afraid that if he learned about his condition and how to treat it, then he would have to adopt an entirely new attitude concerning his own healthcare. So he fears, denies, and avoids.

I share all of this to say that I completely agree with your comment that "we need a new treatment because so many are scared of CPAP and will not adopt it and of those that do start CPAP reportedly 55% fail." Using a CPAP successfully requires a huge effort and there are plenty of people, particularly the elderly, who are ill-equipped to make such an effort.

I also agree with your belief that 50% of our population has sleep apnea or will develop it. I think it's much more prevalent than people realize.

wearysoul

[DoriC]

In my case, I know my husband was looking to me to allay his fears and make decisions about his dx and treatment. So although I was completely overwhelmed, frightened and unprepared, I somehow managed to convey to him that I was proud of his "willingness" to do this and we're in this together. I just led him to it and thankfully he followed although I didn't really know where I was going at the time. We've had lots of adjustments to make and I won't say it's been easy, he's doesn't fight it anymore, just leaves it up to me so I had to educate myself here in a hurry and I'm still learning but less anxious even though I sometimes feel burdened with this responsibility. The only thing that keeps me going is seeing the improvements in his daily life, energy, alertness, better humor,etc. I wish the same for you and your father. Dori

[provider]

I have to post my 2 cents. In the DME business we've seen an increasing amount of older referrals coming from sleep specialists not just geriatricians.

A trend we've noticed is it is much more difficult for these patients to become compliant. I'm interested to see any future studies on the topic of apnea in geriatrics as it is near to my heart.

[midnightdweary]

"Elderly-ness" is all in the mind. I do not consider myself elderly. (at 71)
I consider myself "older and wiser" and that I have finally reached a "mature" age.
We are elderly when:
(1)we dress old. (2)Our major topics of conversation when we get with our friends is "Have you heard of any new diseases lately?" (3) Our grandkids become our other major topic of conversation, and we show their pictures to everyone. (I will resist the urge to show you pics of my new 5 month old daugher) (4)Our health (or lack of) is always on the front burner and then it begins to affect our outlook on life. (5)Our mind closes to new ideas and we become "set in our ways", resistant to change. (6)we lose our zest for life.

Jay

[midnightdweary]

Sorry, i meant to say granddaughter (I am not quite THAT non-elderly)

[Pugsy]

Sorry, i meant to say granddaughter (I am not quite THAT non-elderly)

Ahhh, And I was just going to comment on "how very young" you were..

My mother is 78. She exhibits some signs of OSA yet refuses to even consider it. "I am too old" "I couldn't sleep with that on my face" "I don't nap"(big laugh here, she has nodded off often while talking) "I can't" "I won't"..... I could go on and on with the excuses. She is so stubborn and so set in her ways I just don't even go down that road with her. Just stresses us both out without having any positive conclusion.

Lots of denial in her life. So why stop now? I can see why older patients just starting out with therapy might have a high failure rate. If the attitude is "I can't" then they probably "won't". Not all that different from those of us youngsters not quite hitting the 60's..