Educational AimsTo provide a comprehensive, up-to-date review of the prevalence of obstructive sleep apnoea in older peopleTo describe the mechanisms of central and obstructive sleep apnoea in older peopleTo outline the symptoms of sleep apnoea in older peopleTo discuss the evidence base for the treatment of obstructive sleep apnoea syndrome in older people.SummaryObstructive sleep apnoea is a common disorder in older people, with between 13 and 32% of people over 65 yrs old having some sleep apnoea. The variation in the estimated prevalence is likely to reflect the different health status of the older populations studied and the definitions of the disease. This review will address the prevalence and aetiology of sleep apnoea in older people; outlining the possible consequences and treatment options. Age-related changes in chemosensitivity, and sleep architecture may promote central sleep apnoea in older people; while obstructive sleep apnoea is likely to be the result of increased collapsibility of the upper airway; possibly due to changes in upper airway anatomy and muscle function. The consequences of sleep apnoea in older people are unclear, since both sleep apnoea and aging reduce sleep quality and cognitive function. Moreover, there may be a survival advantage of mild sleep apnoea on the cardiovascular system in older people. Therefore the therapeutic advantages of continuous positive airway pressure in older people require further investigation. If future studies demonstrate that continuous positive airway pressure therapy produces a therapeutic benefit in older people this could result improvements in care.

SUMMAR Y The occurrence of cardiovascular events increases in the morning, and while the mechanism responsible is yet to be determined, possible contributors include surges in sympathetic activity and concurrent rises in blood pressure (BP). This study tested the hypothesis that the increase in sympathetic dominance and the surge in BP were greater when waking spontaneously from Stage 2 sleep compared with waking from rapid eye movement (REM) sleep. Twenty healthy young adults had overnight polysomnography, including electrocardiogram measurements. Spectral analysis of heart rate variability (HRV) was conducted on 2-min blocks of stable data selected from the last 30 min of sleep and during 30 min of resting wakefulness (supine) immediately following sleep. Outputs included absolute low frequency (LF) and high frequency (HF) power, the LF ⁄ HF ratio, heart rate (HR) and BP. To investigate the effect of waking from Stage 2 or REM sleep on HRV and BP responses, two-way analyses of variance (anovas) (Stage 2 versus REM) with repeated measures (sleep versus morning wakefulness) were performed. It was found that waking from Stage 2 sleep was associated with significant increases in HR (P = 0AE002) and BP (P < 0AE001), as well as a tendency towards an increase in the LF ⁄ HF ratio (P = 0AE08), whereas measurements during REM sleep and subsequent wakefulness were similar (P > 0AE05). The greater increase in BP and HR when waking from Stage 2 sleep compared with REM sleep suggests that in vulnerable populations, waking from Stage 2 sleep could be an adjunct risk factor of cardiovascular events during the morning period.

No abstract