Sleep Disorders in the Older Adult – A Mini- Review. The most common primary sleep disorders in the elderly population are: sleep- disordered breathing (SDB), REM sleep- behavior disorder (RBD) and restless legs syndrome/periodic limb movements in sleep (RLS/PLMS). Sleep- Disordered Breathing. SDB describes a range of respiratory events that occur periodically during sleep, from simple snoring at the milder end of the spectrum to complete cessation of airflow (apnea) at the more severe end. The number of instances of apnea and hypopnea (partial reduction in airflow) per hour of sleep is called the Apnea- Hypopnea Index (AHI). SDB diagnosis is made when a patient has an AHI > 5–1. Sleep- disordered breathing is more prevalent in the older population and even more common in elderly nursing home patients, especially among those who suffer from dementia. In a large study of randomly selected community- dwelling elderly, 6. Ancoli- Israel et al. In a longitudinal study that followed older adults for 1. Ancoli- Israel et al. The Sleep Heart Health Study . For ages 7. 0–7. 9, 3. AHI 5–1. 4 and 2. AHI . For ages 8.
AHI 5–1. 4 and 2. AHI . These SDB prevalence results in the elderly are in contrast to the prevalence of SDB among middle- aged adults, which is estimated at 4% for men and 2% for women defined by an AHI . Other conditions that increase the risk of developing SDB include: the use of sedating medications, alcohol consumption, family history, race, smoking and upper airway configuration. The main symptoms of SDB in the elderly population are snoring and EDS. Gooneratne et al. Most studies have suggested that older adults with SDB are excessively sleepy and that SDB likely contributes to decreased quality of life, decreased cognitive impairment and greater risk of nocturia, hypertension and cardiovascular disease . The Sleep Heart Health Study found that the risk of developing cardiovascular disease, including coronary artery disease, congestive heart failure and stroke, is positively related with the severity of SDB . It has long been the belief that the amount of sleep needed per night decreases with age. Yet, in a national survey of older adults, the. The prevalence of obesity has increased from 23% to 31% over the recent past in the United States, and 66% of adults are overweight. 1,2 Proposed explanations for the. The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Research from JAMA Internal Medicine — Effects of Exercise Training on Older Patients With Major Depression. Trading in Binary Options or other off-exchange products carries a high level of risk and may not be suitable for everyone. Before trading, you are strongly advised. A recent study in acute ischemic stroke patients reported that SDB was common, particularly in older male patients with diabetes and a nighttime stroke onset . In the older adult, severe SDB (AHI . Older adults with milder SDB (AHI 1. First, a complete sleep history should be obtained focusing on the symptoms of SDB. Special attention should be given to snoring severity, unintentional napping and EDS. Assessment of sleep disturbances is more effective when the bed partner or caregiver is present since he or she is more likely to be aware of the subject's behavior during sleep. Assessments should consider the presence of other sleep disorders (i. RLS) and also sleep- related habits that may confound adequate sleep (i. The patient's detailed medical history should be reviewed, paying attention to SDB- associated medical conditions, medications, the use of alcohol and evidence of cognitive impairment. If assessment is suggestive of SDB, an overnight recording should be obtained for confirmation of the disorder. The most common and proven treatment for SDB is continuous positive airway pressure (CPAP). CPAP compliance could be an issue in all age groups, yet clinicians should not assume that older adults will be less compliant simply due to their age. The bottom line, therefore, is that if the SDB is associated with clinical symptoms, it should be treated regardless of the age of the patient . Patients typically describe RLS as an uncomfortable sensation in their legs that is accompanied by the urge to move. Movement provides temporary relief of this uncomfortable sensation. Aims and scope The Netherlands Journal of Medicine publishes papers in all relevant fields of internal medicine. In addition to reports of original clinical and. This course is designed to help physicians prepare for the ABIM certifying examination in internal medicine. The course is led by a distinguished faculty. The only official Kaplan Lecture Notes for USMLE Step 1 available for sale! Get the comprehensive information you need to ace USMLE Step 1 and match into the. Other terms that are used to describe this sensation include: creepy- crawly, electric current, crazy legs, worms moving, ants crawling or pain. Similar to PLMS, the etiology of RLS is unknown but is associated with iron deficiency states (including pregnancy), uremia, peripheral neuropathy and radiculopathy. Diagnosis of RLS is done on the basis of history alone. Asking the question, . These leg movements characteristically occur every 2. Each jerk or kick may result in an arousal or a brief awakening which causes sleep fragmentation and might lead to complaints of EDS. Since the patients are not aware of these kicks, the complaints might be wrongly interpreted as insomnia. For assessment, a bed partner might be helpful since they are most likely aware of their partner's excessive movements during the night. Diagnosis of PLMS should be based only on an overnight polysomnogram showing a calculated periodic limb movement index (the number of limb movements per hour of sleep) . The etiology of PLMS is unknown. In the absence of RLS, there may be little clinical significance to PLMS. PLMS and RLS are both common in the older adult. The prevalence of both RLS and PLMS increases significantly with age . Ropinirole and pramipexole are the only drugs that are FDA- approved for RLS, but the off- label use of other dopamine agonists (e. Patients with this sleep disorder are often described as . This disorder is characterized by the display of elaborate movements during REM sleep. These can include kicking, punching, running and/or yelling. The patient's uncontrolled movements are sometimes aggressive and/or violent, and might result in injuries either to the patient himself and/or the patient's bed partner. The etiology of chronic RBD is currently unknown, yet it appears to be strongly related to a number of underlying neurological or neurodegenerative disorders. Approximately 4. 0% of RBD cases are related to such conditions. Some data suggest that RBD may be the first manifestation and/or indication of a neurodegenerative disease . In one study, 5. 0% of those diagnosed with RBD developed Parkinson's disease or Multiple System Atrophy within 3–4 years . RBD is more common in the elderly, with a significantly higher prevalence in older men. The diagnosis of RBD requires a thorough sleep history which should be conducted in the presence of the patient's bed partner. Recently, a new screening questionnaire was developed and validated . An overnight polysomnography recording which includes video recording is helpful in confirming the disorder. Close attention should be given to the presence of intermittent elevations in muscle tone or limb movements on the electromyelogram channel during REM sleep. This finding is highly suggestive of RBD.
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