Prevalence and correlates of sleep-disordered breathing in older men: osteoporotic fractures in men sleep study

Abstract

Objectives: To determine the prevalence and distribution of sleep-disordered breathing and associated correlates in a large cohort of older men using several standardized definitions.

Design: Cross-sectional analyses.

Setting: Six U.S. communities.

Participants: Polysomnography was performed on 2,911 participants of the Outcomes of Sleep Disorders in Older Men Sleep Study (mean age+/-standard deviation 76.38+/-5.53; body mass index 27.17+/-3.8 kg/m(2)).

Measurements: Three outcomes were assessed: sleep-disordered breathing (respiratory disturbance index > or =15), obstructive apnea (obstructive apnea index > or =5), and central apnea (central apnea index > or =5).

Results: The prevalence of moderate-severe sleep-disordered breathing was estimated to be 21.4% to 26.4%. Multivariable logistic regression models demonstrated that age (adjusted odds ratio (AOR) per 5-year increase =1.24, 95% confidence interval (CI)=1.15-1.34), obesity (AOR=2.54, 95% CI=2.09-3.09), Asian versus Caucasian race (AOR=2.14, 95% CI=1.33-3.45), snoring (AOR=2.01, 95% CI=1.62-2.49), sleepiness (AOR=1.41, 95% CI=1.11-1.79), hypertension (AOR=1.26, 95% CI=1.06-1.50), cardiovascular disease (AOR=1.24, 95% CI=1.19-1.29), and heart failure (AOR=1.81, 1.31-2.51) were independently associated with sleep-disordered breathing; snoring (AOR=2.10, 95% CI=1.67-2.70), age (AOR per 5-year increase=1.27, 95% CI=1.18-1.38), obesity (AOR=1.48, 95% CI=1.21-1.82), and heart failure (AOR=1.60, 95% CI=1.15-2.24) were associated with obstructive apnea; and age (AOR=1.33, 1.17-1.50) and heart failure (AOR=1.88, 95% CI=1.17-3.04) were associated with central apnea.

Conclusion: Regardless of definition, a high prevalence of sleep disorders is observed in community-dwelling older men. Qualitatively similar associations were observed between sleep disorders and snoring, obesity, and comorbidities, as reported for middle aged populations. Asian race was associated with sleep-disordered breathing.

Figure 1

Sleep-disordered breathing (SDB) prevalence estimates with 95% confidence intervals are illustrated based upon respiratory disturbance index (RDI) cutoffs of 5 (P-value for trend = .68) and 15 (P-value for trend = .005) according to age quartile.

Figure 2

Sleep-disordered breathing (SDB) prevalence estimates with 95% confidence intervals are illustrated based upon respiratory disturbance index (RDI) cutoffs of 5 (P-value for trend < .001) and 15 (P-value for trend < .001) according to body mass index (BMI) quartile.

Figure 3

Bland-Altman Plot for the Sleep Heart Health Study (SHHS) versus American Academy of Sleep Medicine (AASM)-defined hypopneas to determine sleep apnea severity. The dashed lines represent the 95% confidence intervals of the mean difference; the solid line represents the mean difference.