There is an average sleep period, which varies between 6-10 hours per day. Sleep duration is genetically determined and may vary with age, health, and emotional status (7). Typically, people at geriatric age groups fall asleep late, and their total sleep time decreases compared to the adults. This might be explained by the changes happening to the organ functions with aging and its impact on sleep neurophysiology[ 8]. OSAS usually is twice as common in males, while in the geriatric age group, female to male ratios are similar as time progresses [ 9 ]. The lower frequency of OSAS in women of the pre-menopausal stage than men has been linked to the different distribution of fat due to sex hormones . According to some studies, overweight is not typical in geriatric OSAS patients, unlike adults . In our study, while there was a significant difference between geriatric and adult groups in terms of body mass index (BMI), there was no significant difference in terms of height and weight. In terms of gender distribution, there was no difference between the two groups. Based on literature information, OSAS is more common in men, and the population of our study is consistent with the literature.
OSAS has consequences that concern many systems, especially the cardiovascular system (CVS). The primary outcomes of OSAS on CVS are hypertension, cardiac arrhythmias, ischemic heart diseases, and myocardial infarction(12,13). It is also an inducing and aggravating factor for metabolic diseases such as diabetes . The relationship between chronic respiratory diseases (COPD, Asthma, CRF) and OSAS is slightly different. But Sanders et al. has reported in their study that this relationship is coincidental and that there is no specific physiological mechanism supporting the formation of OSAS in patients with chronic respiratory diseases . Besides, patients with this combination have a higher risk of developing chronic respiratory failure than patients with only OSAS [ 16]. Similarly, in this study, we observed a significant difference in the geriatric age group in terms of coronary artery disease (CAD) and hypertension. In contrast, in terms of diabetes, COPD, and asthma rates, there was no significant difference between the geriatric age group and the adult group. In our study, the incidence of CRF diseases was similar in both groups.
Factors that reduce muscle tones such as fatigue, overweight, substance use, chronic nasal congestion, and sleeping position on its back are the leading causes of snoring as they increase the muscle resistance in the upper respiratory tract and pharynx [ 17]. Most of the snoring patients are not aware of this, and usually, their partner informs the doctor about it because snoring does not wake the patient up unless it is powerful. In geriatric age groups, it was observed that snoring reporting decreased compared to the middle age group which could be possibly explained with the suggestions that their partners who could witness snoring of geriatric patients would be less due to higher passing away rate than adults and increased central apnea frequency in geriatric age groups . In our study, the rate of admission with the snoring complaints was higher in the adult group than geriatric patients. There was no statistical difference between the geriatric and adult groups in terms of smoking and weight.
Many symptoms (such as headache and chest pain, lack of concentration, forgetfulness, psychiatric disorders, sweating, cough, enuresis, libido, and impotence) have been identified in the literature associated with OSAS affecting daily life [ 18-20]. Among these, it was determined that the common headache and chest pain in the adult group might be related to increased carbon dioxide and decreased oxygen saturation when it was crosschecked with the literature(21). However, the psychological complaints of sleepwalking, insomnia, and dry mouth complaints are more common in adults. In contrast, the complaint of witnessed apnea and excessive daytime sleepiness complaints were more frequently observed in the geriatric patient group.
Minimum O2 saturation and mean O2 saturation measurements of geriatric patients show significantly lower values than adult cases. Light sleep increases in geriatric age groups, and with the increase in the number of wakefulness, the continuity of sleep may worsen, which leads to decreased effectiveness in sleep, daytime sleepiness, and daytime lethargy [ 22]. In our study, mean desaturation measurements were higher in geriatric patients and were statistically significant when the two groups were compared.
In a study that compared two groups with age above 65 and under and aimed to determine the underlying factors related to the severity of OSAS, it was determined that male sex, BMI, and aging were independent risk factors for severe OSAS in the geriatric group [ 23]. Similarly, in our study, there was a statistical difference in aging and BMI of geriatric patients compared to adults.
It is estimated that the incidence of sleep apnea and hypopnea increases during the geriatric period . Sanders, in his study, detected that the prevalence of apnea was higher in the geriatric group than in adults [ 25 ]. However, the relationship between age and the frequency of apnea is not as simple as thought. In comparison to AHI, geriatric age groups have more frequent disorders, but its relationship with morbidity and mortality that happens due to daytime sleepiness is not clear. . The increase of the disease with age was not found as pronounced in the age group above 65 as under the age of 65. But, it is not entirely clear whether age alone increases the risk of apnea and AHI. . In the study of Kripke et al., 427 geriatric patients were monitored in 5 years, and it was shown that AHI increased with age (28). In the study conducted by Hock et al. With 105 geriatric patients, a significant increase was found in AHI, mean apnea count, and OSAS (obstructive sleep apnea syndrome) prevalence from 60 to 90 years of age. (29). In our study, apnea, AHI, and aurosol were statistically higher in the geriatric OSAS group, and mean oxygen saturation was lower in geriatric patients. All of these show us that geriatric age groups have more sleep apnea-hypopnea complaints and are consistent with literature records.
Recent reports have shown that the worsening of upper respiratory muscles may be partly responsible for the further deterioration of OSAS in geriatric age groups and that decreased skeletal muscle function is an essential physical disease associated with aging [ 30 ]. In another study, PAP levels were strongly correlated with BMI, AHI, upper respiratory tract, and critical pharyngeal pressure [ 31]. In this study, high levels of AHI in geriatric age groups, changes in the upper respiratory tract with age, and high rates of apnea increased the need for PAP use in treatment, and the rates of PAP usage were statistically higher in geriatric patients compared to adults.
It is important to note that sleep condition should not be interpreted as a pathological phenomenon in geriatric age groups less than an hour and just afternoon. The reduction was statistically significant in geriatric patients with nrem2 (%) and nrem3 (%), as well as with nrem3 and REM measurements compared to adult patients. Studies have shown that the architecture of Geriatric sleep changes due to decreased deep, slow sleep [22 ]. Similar results were obtained in our study. This study has some limitations that need to be stated. Recently, seasonal changes associated with the humidity of the air during sleep have been reported. We have not analyzed the seasons in which PSG have been conducted.