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OSA in older adults

Obstructive sleep apnea (OSA) is caused by obstruction of the upper airway and is the most common sleep disorder among older adults.

Sleep apnea interferes with mental alertness and quality of life and can lead to a number of complications, ranging from daytime sleepiness to possible increased risk of death. It has a strong association with several diseases, particularly those related to the heart and circulation. It leads to daytime sleepiness which increases the risk for accident-related injuries.

Association of OSA with other diseases

OSA and Cardiovascular Disease

Patients with OSA have higher blood pressures and are prone to hypertension and heart diseases. Cross-sectional and case-control studies have suggested an increased risk for coronary artery disease/myocardial ischemia, cerebrovascular accidents and cardiomyopathy. In patients with preexisting cardiovascular disease, the evidence for increased morbidity and mortality is even stronger.

OSA and Cognitive Function

Obstructive Sleep Apnoea adversely affects different aspects of cognitive function like delayed memory recall and executive function along with verbal recall and constructional abilities. OSAS patients also exhibit retrieval deficit of episodic memory but intact maintenance, recognition and forgetfulness.

Treatment of OSA

Dental Appliances & Surgery

Dental appliances that modify the position of the tongue or jaw have been used to treat OSA with varying degrees of success. Several different dental devices are available like:

  • Mandibular advancement device (MAD). This is the most widely used dental device for sleep apnea. MAD forces the lower jaw forward and down slightly, which keeps the airway open.
  • Tongue retraining device (TRD). This is a splint that holds the tongue in place to keep the airway as open as possible.
  • An orthodontic treatment called rapid maxillary expansion, in which a screw device is temporarily applied to the upper teeth and tightened regularly, may help patients with sleep apnea and a narrow upper jaw. This nonsurgical procedure helps to reduce nasal pressure and improve breathing.

These devices remain a second line therapy, especially for patients with severe disease.

Surgical procedures have a long history in the treatment of OSA for correction of anatomical abnormalities. A procedure known as uvulopalatopharyngoplasty (UPPP) may help some patients improve or even eliminate their obstructive sleep apnea (OSA).

The combination of several surgical procedures addressing different areas of airway obstruction may improve success rates.

CPAP therapy

Continuous positive airway pressure therapy (CPAP) uses a machine to help a person who has obstructive sleep apnea (OSA) breathe more easily during sleep. Research shows that continuous positive airway pressure (CPAP) decreases daytime sleepiness, especially in those who have moderate to severe sleep apnea. Studies show that in people who have moderate to severe sleep apnea, nasal continuous positive airway pressure (NCPAP) lowers blood pressure during both the day and the night while people with coronary artery disease who use CPAP for sleep apnea are less likely to have heart problems such as heart failure. In patients with OSA, CPAP usage is associated with improvement in

  • Attention
  • Psychomotor speed
  • Executive Function
  • Nonā€verbal delayed recall

What should be kept in mind however is that proper compliance should be followed. Resolution of symptoms with therapy also appears to be associated with enhanced compliance.

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About Our Doctor

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Dr Sitoh Yih Yiow is a consultant geriatrician who graduated from the National University of Singapore in 1991. He obtained his Membership of the Royal College of Physicians of the United Kingdom in 1996 and was awarded a Higher Manpower Development Programme (HMDP) fellowship by the Ministry of Health... Read more about our doctor