Recognition and Diagnosis of Obstructive Sleep Apnea in Older Americans

Abstract

Objectives: To estimate the proportion of older Americans at risk for obstructive sleep apnea (OSA) who receive OSA evaluations, diagnosis, and treatment.

Design: Cross sectional study.

Setting: National Health and Aging Trends Study (NHATS), Round 3 survey.

Participants: Community-dwelling Medicare beneficiaries age 65 and older (N=1,052).

Measurements: NHATS participants were asked specific questions about sleep disturbances, including items that resembled critical elements of a validated instrument used to assess OSA risk (the STOP-Bang questionnaire). The proportion of older Americans at risk for OSA who received evaluations with home or in-laboratory sleep studies, OSA diagnosis, and OSA treatment was examined, as well as clinical, social, and demographic correlates of OSA.

Results: Of 1,052 participants who completed the sleep module, 56% (95% confidence interval (CI)=53-59%) were estimated to be at high risk of OSA. Only 8% (95% CI=5-11%) of the high-risk individuals had been tested for it. Of those tested, 94% (95% CI=87-100%) were diagnosed with OSA. Treatment with positive airway pressure was prescribed for 82% (95% CI=65-99%) of participants with an OSA diagnosis.

Conclusions: Evidence from this nationally representative sample of community-dwelling Medicare beneficiaries suggests that high OSA risk is common but seldom investigated. When investigated, OSA is almost always confirmed and usually treated. These findings suggest a significant gap in OSA assessment for older Americans that could have public health implications.

Keywords: Medicare; National Health and Aging Trends Study; STOP-BANG; obstructive sleep apnea; polysomnography.

Figure 1

Proportion of OSA recognition and treatment among ‘At Risk’ NHATS participants (PSG=polysomnography, HSAT=home sleep apnea testing); N=1,052 respondents reflects the unweighted sample frequencies that represent 7,082,963 older Americans in the general population.