Sleep Apnea, Sleepiness, and Mortality in Older Adults

In this months edition of the Sleep Journal there is an article about obstructive sleep apnea (OSA), excessive daytime sleepiness (EDS), and mortality risk in the elderly. Studies have not been able to conclusively show that OSA increases the risk of death in older adults. Studies have shown that EDS (from whatever cause) does increase mortality risk in older adults.

Researchers studied 289 patients greater than age 65 years old and followed them for an average of 13.8 years. EDS was assessed with subjective questionnaires and objective testing - MSLT. OSA was measured with an overnight sleep study.

The results showed that EDS by itself increased mortality risk and that EDS with OSA increased it even more. However, OSA without EDS did not increase mortality risk. The study authors concluded that OSA with EDS is significant, and that treatment should be discussed with the patient.

Bottom Line: The findings support my and the authors current practices for treating OSA in the elderly. Treatment is not necessarily warranted for mild OSA in the absence of EDS. In those with OSA and EDS, treatment should be offered. In those with moderate to severe OSA without EDS, decisions to treat should be made on an individual basis.