Academic journal article Scholarly Inquiry for Nursing Practice

Sleep Apnea in Alzheimer's Patients and the Healthy Elderly

Academic journal article Scholarly Inquiry for Nursing Practice

Sleep Apnea in Alzheimer's Patients and the Healthy Elderly

Article excerpt

The incidence of sleep apnea was explored in 80 elderly subjects. Through the use of several criteria, sleep apnea was found more frequently in Alzheimer's patients (n = 24) than in healthy controls (n = 56). Alzheimer's patients were also found to have a significantly higher proportion of apnea related to non-rapid eye movement than to rapid eye movement sleep. Apnea-positive Alzheimer's patients also had significandy more awake time during the course of die night. A significant positive correlation between apnea index and severity of dementia, as measured by the Blessed Dementia Rating Scale, was found for apneapositive Alzheimer's patients (r=0.57, p<.0l) as well as for the entire sample of Alzheimer's patients (r=0.41,p<.05). Neuropathological implications are discussed, as are implications for nursing practice.

Sleeping and breathing are basic physiological functions affected both by each other and by the process of aging. Alterations in patterns of sleeping and wakefulness have been identified by sleep researchers as consistent signs of biological aging (Carskadon & Dement, 1981; Feinberg, Koresko, & Heller, 1967; Feinberg, 1974; Kahn & Fisher, 1969; Kahn, Fisher & Lieberman, 1970; Kales, Wilson, & Kales, 1967; Miles & Dement, 1980; Prinz, 1977; Reynolds et al., 1985a). Studies indicate that sleep-disordered breathing increases with advancing age. Reported rates of prevalence of apnea during sleep have ranged from 27 to 76% in men age 60 and over and have been found to be as high as 32% in women of the same age group (Ancoli-Israel, Kripke, Mason, & Messin, 1981; Ancoli-Israel, Kripke, Mason & Kaplan, 1985; Bixler et al., 1981; Kripke & Ancoli-Israel, 1983; Moldofsky et al., 1983; Reynolds et al., 1985b; Smallwood, Vitiello, Giblin, & Prinz, 1983).

There are, however, various methodological differences among reported studies with respect to the measurement of sleep apnea. These differences include laboratory versus home monitoring, airflow and respiratory effort versus oxygen desaturation measurements, and polysomnographic sleep recordings versus respiratory monitoring only. Moreover, criteria for defining sleep apnea vary, ranging from 30 or more episodes of apnea during sleep each night to more than 5 or 10 apneic events during each hour of sleep (Berry, Webb, & Block, 1984; Guilleminault & Dement, 1982; Smallwood et al., 1983).

Sleep apnea may be a major source of nocturnal sleep disturbance and daytime sleepiness in elderly persons. It may also be a source of potential morbidity and mortality related to the use of sedative-hypnotic drugs for sleep (Hayter, 1985; Kripke & Ancoli-Israel, 1983). Although sleep apnea frequently presents with prominent neuropsychiatric symptoms, relatively little data have been published on the occurrence of sleep-disordered breathing in one of the most common neuropsychiatric disorders of old age, namely, Alzheimer's disease. Some investigators have reported an increased prevalence of sleep apnea among Alzheimer's patients as compared to controls (Reynolds et al., 1985b; Smirne et al., 1981); others have not (Smallwood et al., 1983).

The rationale for the current study was threefold. First, research comparing the effects of healthy and pathological aging on sleep-disordered breathing is sparse. Second, variability in regard to methodology and objective measures of sleep apnea is considerable among reported studies. Finally, sleep apnea has an impact on nursing practice with the elderly. Nurses have consistent contact with elderly people in a variety of primary, secondary, and tertiary care settings and are responsible for the development and implementation of care plans that are in keeping with the unique needs of this population. Thus, the purposes of this descriptive study were to: (a) ascertain the frequency and type of sleep apnea experienced by healthy elderly people and elderly people with dementia, (b) compare definitions (that is, criteria) of sleep apnea within the same sample, (c) correlate electroencephalographic (EEC) sleep measures and sleep apnea within groups, (d) correlate measures of cognitive deterioration and sleep apnea within groups, (e) assess differences in apnea occurring during different stages of sleep between groups, and (f) delineate preliminary nursing assessment and intervention guidelines relative to sleep apnea among the elderly. …

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