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Sleep disordered breathing in the elderly: comparison of women and men

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The prevalence of obstructive sleep apnea syndrome in patients up to the age of 60 is known to be two times higher in men then in women. Hormonal changes during menopause might underlie changes in this relationship in the elderly. This study was designed to detect differences in the type and frequency of sleep-disordered breathing between women and men over the age of 65 years, having the same body mass index. The study was conducted using a matched-pair approach consisting of a sample population of 40 pairs of patients over the age of 65. All patients met the following exclusion criteria: age below 65, heart failure, chronic obstructive lung disease. Polygraphy was conducted by means of a portable recorder. All measured indices were higher in men than in women. The apnea index was 2.8 ±4.1 in men and 0.6 ±1.4 in women. The apnea/hypopnea index was 10.2 ±11.4 and 4.8 ±3.9, respectively. These differences were significant (P<0.05). Significant differences also were observed when central (men 8.1 ±13.1, women 3.1 ±8.2), mixed (men 5.1 ±11.4, women 0.4 ±1.3), and obstructive (women men 8.6 ±20.1, 1.0 ±4.3) apnea indices were compared. In conclusion, the study demonstrates that elderly patients showed gender-dependent differences in the type and frequency of sleep-related breathing disorders. Men suffered from all kinds of apnea more frequently than women.
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Sleep disordered breathing in the elderly: a three year longitudinal cohort study

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The objective of this investigation was to assess the association between the presence of sleep disordered breathing (SDB) and daytime sleepiness, body mass index, hospitalisation, and survival. To this end, a prospective longitudinal study was conducted in the elderly population consisting of 80 patients of either sex over the age of 65 years admitted to a city hospital in Germany without any history of SDB. All patients met the following exclusion criteria: age <65 yr, heart failure, and chronic obstructive lung disease. Baseline anthropometric and cardiorespiratory (one-night portable polygraphic recording) data, and a standardized sleep and sleepiness-questionnaires (Epworth Sleepiness Scale, ESS) were obtained in 1999. A second screening was conducted in 2003. Thirty one women and 34 men completed the follow-up after 3 years. These patients were divided into two subgroups: (i) no clinically relevant SDB and (ii) SDB (apnea-hypopnea index, AHI, 5 plus excessive day time sleepiness, ESS, >9). Six men and 3 women fulfilled the criteria of SDB. Thirty three percent of patients with SDB and 20% of patients without SDB died during the follow-up period. Duration of hospital stay was 35 days for the SDB patients and 20 days for patients without it. Body weight and sleepiness did not change significant over the 3-year period between the two cohorts. We conclude that the presence of SDB was associated with a 1.5-fold higher mortality and longer hospital stay in elderly patients over a period of 3 years even in persons without previous history of SDB. Daytime sleepiness was a better predictor than AHI or BMI for death.
Lumbar disc degeneration is characterised radiologically by the presence of osteophytes, endplate sclerosis, and disc space narrowing. Our study was designed to assess anterior lumbar osteophytes, disc space narrowing, end plate sclerosis, and bone mineral density (BMD) in the lumbar vertebrae and femoral neck of elderly men. A total of 1000 men, aged between 71 and 90 years, were invited to participate in the study. BMD was assessed at the spine and femoral neck using dual energy X-ray absorptiometry (DXA). We examined the relationship with the degree of lumbar spinal and femoral neck deformity by using the Z-score. Lateral and anterioposterior spinal radiographs were evaluated for features of lumbar disc degeneration. The observers consisted of a consultant physical therapist, a radiologist, and anatomists who together studied the series of radiographs. Anterior lumbar osteophytes (grade 0–3), end-plate sclerosis, and disc space narrowing (grade 0–2) were evaluated. The Pearson correlation test was used to determine the association between radiographic features, the lumbar mineral density (LBMD), and femoral neck mineral density (FNBMD). In all, 90.6% of lumbar vertebral levels showed evidence of anterior osteophytes, 87.5% showed evidence of end plate sclerosis, and 68.2% of disc space narrowing. Additionally, there was a strong negative correlation in terms of age at the femoral neck, though not at the spine. On the other hand, there was a significant correlation between osteophyte grade and end plate sclerosis at the spine. In our study, the radiographic features of lumbar disc degeneration, anterior osteophytes, and end plate sclerosis were associated with an increase in BMD at the spine. (Folia Morphol 2010; 69, 3: 170–176)
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