OSAHS in elderly patients with insomnia

OSAHS IN ELDERLY PATIENTS WITH INSOMNIAPilot studyCéline DegrandeJustine DegrandeJustine MestdaghAstrid VerschaeveSupervisor Prof. Dr. Degryse

2

Table of contents

Goal of the pilot study Background Methods Results Discussion Conclusion

3

Goal of the Pilot Study

• Prevalence of OSAHS in elderly patients with insomnia

• Validity and practical feasibility of questionnaires

4

A little quiz…

• How often do you think older patients complain of sleep disturbances such as insomnia?o 25%o 50%o 75%o 90%o I don’t know

5

Background: Insomnia• Dissatisfaction with either duration or quality

of sleep.

• 3 fundamental criteria• recurrent• despite adequate opportunities for sleep.• impairment of daytime functioning.

• Most common comorbidities:• psychiatric illness • sleep disordered breathing: OSAHS

• Associated with older age – underdiagnosis:• ‘Ageism’• mental illnesses – cognitive disorders• threshold consulting GP• burden of PSG

6

Background: OSAHS• Prevalence:

o 30-60 years:• ♂: 4%• ♀: 2%

o ↑ prevalence with age: • ♂: 28-62% • ♀: 19,5-60%

• Symptoms:o excessive daytime sleepinesso snoring

• Risk factors: o obesity, male gender, ageing, familial

history, sedating medication,…

• Comorbidities: o cardiovascular o metabolic o neurobehavioral

• Diagnosis:o PSG vs portable device (Brizzy®)

7

Background: Questionnaires

• Insomnia:o ISI

• Sleep quality: o PSQIo ESS

• OSAHS:o BQo STOP-BANG

• Snoring, Tired, Observed, blood Pressure, BMI, Age, Neck circumference, Gender

8

Methods

9

10

Methods

11

Methods

• Exclusion criteriao terminal patients (life expectancy < 3 months)o diagnosis of dementia (MMSE < 24) o acute precipitating factor for insomnia (physical or

psychological) o Already diagnosed with OSAHS by PSG

• Patients already taking sleep medication NOT excluded!

12

Methods

13

Methods

• Home visito Anamnesis

• History patient• CV RF (smoking, alcohol, familial history,

hypertension, hypercholesterolemia)• Medication use

o Clinical examination• Height, weight, neck circumference,

abdominal circumference, blood pressure,

heart rhythm

14

Methods

• Home visito Questionnaires

• PSQI• ESS• Berlin questionnaire• STOP-BANG

15

16

17

18

19

Methods: Brizzy®

20

Methods: JAWAC

21

Results

• Brizzy® report

• Patient characteristics

• Brizzy® analyses

• Questionnaires

22

Brizzy® report

23

24

25

Results: Patient characteristics

26

Results:Brizzy ® reports

A small example….

30

Results:Sensitivity, Specificity, PPV, NPV, AUC and p-value of parameters in Brizzy® reports using optimal cut-off values

31

Results:Questionnaires mean scores and statistic significance

32

Results:Questionnaires sensitivity, specificity, PPV and NPV using normal cut-off values

33

Results:Sensitivity, Specificity, PPV, NPV, AUC of questionnaires using optimal cut-off values

34

Discussion

• Strenghts o Uniformo First step in an unexplored domain

• Limitations o Sample sizeo Brizzy as golden standard o Interobserver variability

35

Discussion

• Underdiagnosis

• Case-finding protocol and ISI as screening tool highly suitable

• Patient characteristics

• RDI – ODI – CT SpO2 < 90%

• Brizzy as a valid ambulant alternative

• ESS – BQ valid questionnaires with optimal cut-off

Conclusion

• OSAHS: severe underdiagnosis • Brizzy as a practical and feasible alternative • Questionnaires in screening

36

37

THANKS FOR YOUR ATTENTION

38

Any questions?