No CrossRef data available.
Article contents
Comparison of Sleep Apnea Questionnaires and Reported Diagnosis in Neurological Disorders of Aging
Published online by Cambridge University Press: 17 May 2024
Abstract :
Background:
Obstructive sleep apnea (OSA) is associated with worse outcomes in stroke, Alzheimer’s disease (AD) and Parkinson’s disease (PD), but diagnosis is challenging in these groups. We aimed to compare the prevalence of high risk of OSA based on commonly used questionnaires and self-reported OSA diagnosis: 1. within groups with stroke, AD, PD and the general population (GP); 2. Between neurological groups and GP.
Methods:
Individuals with stroke, PD and AD were identified in the Canadian Longitudinal Study of Aging (CLSA) by survey. STOP, STOP-BAG, STOP-B28 and GOAL screening tools and OSA self-report were compared by the Chi-squared test. Logistic regression was used to compare high risk/self-report of OSA, in neurological conditions vs. GP, adjusted for confounders.
Results:
We studied 30,097 participants with mean age of 62.3 years (SD 10.3) (stroke n = 1791; PD n = 175; AD n = 125). In all groups, a positive GOAL was the most prevalent, while positive STOP was least prevalent among questionnaires. Significant variations in high-risk OSA were observed between different questionnaires across all groups. Under 1.5% of individuals self-reported OSA. While all questionnaires suggested a higher prevalence of OSA in stroke than the GP, for PD and AD, there was heterogeneity depending on questionnaire.
Conclusions:
The wide range of prevalences of high risk of OSA resulting from commonly used screening tools underscores the importance of validating them in older adults with neurological disorders. OSA was self-reported in disproportionately small numbers across groups, suggesting that OSA is underdiagnosed in older adults or underreported by patients, which is concerning given its increasingly recognized impact on brain health.
Résumé :
Comparaison entre des questionnaires portant sur l’apnée du sommeil et les diagnostics rapportés dans le cas de troubles neurologiques du vieillissement
L’apnée obstructive du sommeil (AOS) est associée à une évolution défavorable de l’état de santé d’individus victimes d’AVC, mais aussi atteints de la maladie d’Alzheimer (MA) et de la maladie de Parkinson (MP). Un diagnostic demeure toutefois difficile à établir dans leur cas. Nous avons ainsi cherché à comparer la prévalence du risque élevé d’AOS sur la base de questionnaires couramment utilisés et de diagnostics auto-déclarés d’AOS au sein : 1) de cohortes de patients victimes d’un AVC ou atteints de la MA, de la MP en comparaison avec la population générale (PG) ; de groupes neurologiques en comparaison avec la PG.
C’est au moyen d’enquêtes que des individus victimes d’un AVC ou atteints de MP et de MA ont été identifiés dans le cadre de l’Étude longitudinale canadienne sur le vieillissement (ELCV). Les outils de dépistage STOP, STOP-BAG, STOP-B28 et GOAL, de même que l’auto-évaluation de l’AOS, ont été comparés à l’aide d’un test du khi carré. Un modèle de régression logistique a par ailleurs permis de comparer le risque élevé ou l’auto-déclaration de l’AOS selon l’état neurologique des patients par rapport à la PG, et ce, en procédant à un ajustement tenant compte de facteurs de confusion (confounders).
Au total, nous avons étudié 30 097 participants dont l’âge moyen était de 62,3 ans (σ 10,3 ; AVC : n = 1791, MP : n = 175, MA : n = 125). Dans tous les groupes, des résultat positifs à l’outil d’évaluation GOA se sont avérés les plus répandus, tandis que des résultats positifs à l’outil STOP étaient les moins répandus. Des variations significatives du risque élevé d’AOS ont été observées entre les différents questionnaires, et ce, dans tous les groupes. Mentionnons aussi que moins de 1,5 % des individus ont déclaré être atteints d’AOS. Alors que tous les questionnaires suggèrent une prévalence plus élevée d’AOS dans le cas des AVC qu’au sein de la PG, on a observé, dans le cas de la MP et de la MA, une hétérogénéité en fonction des questionnaires.
Un large éventail de prévalences de risque élevé d’AOS résultant d’outils de dépistage couramment utilisés souligne en bref l’importance de bien les valider chez les individus âgés qui sont atteints de troubles neurologiques. L’AOS a été auto-déclarée dans une proportion disproportionnellement plus faible dans tous les groupes, ce qui suggère qu’elle demeure sous-diagnostiquée chez les personnes âgées ou sous-déclarée par les patients. Cela est préoccupant compte tenu de l’impact de plus en plus reconnu de ce trouble sur la santé cérébrale.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
References
Heinzer, R, Vat, S, Marques-Vidal, P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3:310–8. DOI: 10.1016/s2213-2600(15)00043-0.Google Scholar
Kapur, V, Strohl, KP, Redline, S, Iber, C, O'Connor, G, Nieto, J. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep Breath. 2002;6:49–54. DOI: 10.1007/s11325-002-0049-5.Google Scholar
Fuhrman, C, Fleury, B, Nguyên, XL, Delmas, MC. Symptoms of sleep apnea syndrome: high prevalence and underdiagnosis in the French population. Sleep Med. 2012;13:852–8. DOI: 10.1016/j.sleep.2012.04.005.Google Scholar
Flemons, WW, Douglas, NJ, Kuna, ST, Rodenstein, DO, Wheatley, J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004;169:668–72. DOI: 10.1164/rccm.200308-1124PP.Google Scholar
Knauert, M, Naik, S, Gillespie, MB, Kryger, M. Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World J Otorhinolaryngol Head Neck Surg. 2015;1:17–27. DOI: 10.1016/j.wjorl.2015.08.001.Google Scholar
Miner, B, Kryger, MH. Sleep in the aging population. Sleep Med Clin. 2017;12:31–8. DOI: 10.1016/j.jsmc.2016.10.008.Google Scholar
Neto, MS, Pereira, M, Sobreira, E, França Fernandes, R, Tumas, V, Eckeli, A. Obstructive sleep apnea syndrome in Parkinson’s disease: preliminary results. Sleep Med. 2013;14:e112. DOI: 10.1016/j.sleep.2013.11.246.Google Scholar
Gaeta, AM, Benítez, ID, Jorge, C, et al. Prevalence of obstructive sleep apnea in Alzheimer’s disease patients. J Neurol. 2020;267:1012–22. DOI: 10.1007/s00415-019-09668-4.Google Scholar
Liu, X, Lam, DC, Chan, KPF, Chan, HY, Ip, MS, Lau, KK. Prevalence and determinants of sleep apnea in patients with stroke: a meta-analysis. J Stroke Cerebrovasc Dis. 2021;30:106129. DOI: 10.1016/j.jstrokecerebrovasdis.2021.106129.Google Scholar
Rosenzweig, I, Glasser, M, Polsek, D, Leschziner, GD, Williams, SC, Morrell, MJJTLRM. Sleep apnoea and the brain: a complex relationship. Lancet Respir Med. 2015;3:404–14.Google Scholar
Boulos, MI. The case for improving the detection and treatment of obstructive sleep apnea following stroke. Can Med Assoc J. 2023;195:E374–E5. DOI: 10.1503/cmaj.230240.Google Scholar
Bubu, OM, Andrade, AG, Umasabor-Bubu, OQ, et al. Obstructive sleep apnea, cognition and Alzheimer’s disease: a systematic review integrating three decades of multidisciplinary research. Sleep Med Rev. 2020;50:101250. DOI: 10.1016/j.smrv.2019.101250.Google Scholar
Gosselin, N, Baril, AA, Osorio, RS, Kaminska, M, Carrier, J. Obstructive sleep apnea and the risk of cognitive decline in older adults. Am J Respir Crit Care Med. 2019;199:142–8. DOI: 10.1164/rccm.201801-0204PP.Google Scholar
Costa, YS, Lim, ASP, Thorpe, KE, et al. Investigating changes in cognition associated with the use of CPAP in cognitive impairment and dementia: a retrospective study. Sleep Med. 2023;101:437–44. DOI: 10.1016/j.sleep.2022.11.037.Google Scholar
Shieu, MM, Zaheed, A, Shannon, C, et al. Positive airway pressure and cognitive disorders in adults with obstructive sleep apnea: a systematic review of the literature. Neurology. 2022;9:e334–46. DOI: 10.1212/wnl.0000000000200383.Google Scholar
Kaminska, M, Mery, VP, Lafontaine, AL, et al. Change in cognition and other non-motor symptoms with obstructive sleep apnea treatment in Parkinson disease. J Clin Sleep Med. 2018;14:819–28. DOI: 10.5664/jcsm.7114.Google Scholar
Ryan, CM, Bayley, M, Green, R, Murray, BJ, Bradley, TD. Influence of continuous positive airway pressure on outcomes of rehabilitation in stroke patients with obstructive sleep apnea. Stroke. 2011;42:1062–7. DOI: 10.1161/strokeaha.110.597468.Google Scholar
Parra, O, Sánchez-Armengol, A, Bonnin, M, et al. Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial. Eur Respir J. 2011;37:1128–36. DOI: 10.1183/09031936.00034410.Google Scholar
Aaronson, JA, Hofman, WF, van Bennekom, CA, et al. Effects of continuous positive airway pressure on cognitive and functional outcome of stroke patients with obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2016;12:533–41. DOI: 10.5664/jcsm.5684.Google Scholar
Ramachandran, SK, Josephs, LA. A meta-analysis of clinical screening tests for obstructive sleep apnea. Anesthesiology. 2009;110:928–39. DOI: 10.1097/ALN.0b013e31819c47b6.Google Scholar
Raina, PS, Wolfson, C, Kirkland, SA, et al. Ascertainment of chronic diseases in the Canadian longitudinal study on aging (CLSA), systematic review. Can J Aging. 2009;28:275–85. DOI: 10.1017/s071498080999002x.Google Scholar
Oremus, M, Postuma, R, Griffith, L, et al. Validating chronic disease ascertainment algorithms for use in the Canadian longitudinal study on aging. Can J Aging. 2013;32:232–9. DOI: 10.1017/s0714980813000275.Google Scholar
Chung, F, Yegneswaran, B, Liao, P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21. DOI: 10.1097/ALN.0b013e31816d83e4.Google Scholar
Waseem, R, Salama, Y, Baltzan, M, Chung, F. Comparison of STOP-Bang and STOP-Bag questionnaires in stratifying risk of obstructive sleep apnea. Can J Respir Crit Care Sleep Med. 2022;6:1–8. DOI: 10.1080/24745332.2022.2057883.Google Scholar
Nagappa, M, Liao, P, Wong, J, et al. Validation of the STOP-bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One. 2015;10:e0143697. DOI: 10.1371/journal.pone.0143697.Google Scholar
Martins, EF, Martinez, D, Cortes, AL, Nascimento, N, Brendler, J. Exploring the STOP-BANG questionnaire for obstructive sleep apnea screening in seniors. J Clin Sleep Med. 2020;16:199–206. DOI: 10.5664/jcsm.8166.Google Scholar
Duarte, RL, Magalhães-da-Silveira, FJ, Oliveira, ESTS, Silva, JA, Mello, FC, Gozal, D. Obstructive sleep apnea screening with a 4-item instrument, named GOAL questionnaire: development, validation and comparative study with No-Apnea, STOP-bang, and NoSAS. Nat Sci Sleep. 2020;12:57–67. DOI: 10.2147/nss.S238255.Google Scholar
CLSA TECHNICAL DOCUMENT. Sampling and computation of response rates and sample weights for the tracking (Telephone interview) participants and comprehensive participants. Can Longitud Study Aging. 2017. https://www.clsa-elcv.ca/doc/1041. Accessed 19 March 2024.Google Scholar
Hasan, F, Gordon, C, Wu, D, et al. Dynamic prevalence of sleep disorders following stroke or transient ischemic attack: systematic review and meta-analysis. Stroke. 2021;52:655–63. DOI: 10.1161/strokeaha.120.029847.Google Scholar
Laratta, CR, Ayas, NT, Povitz, M, Pendharkar, SR. Diagnosis and treatment of obstructive sleep apnea in adults. CMAJ. 2017;189:E1481–E1488. DOI: 10.1503/cmaj.170296.Google Scholar
Braley, TJ, Dunietz, GL, Chervin, RD, Lisabeth, LD, Skolarus, LE, Burke, JF. Recognition and diagnosis of obstructive sleep apnea in older Americans. J Am Geriatr Soc. 2018;66:1296–302. DOI: 10.1111/jgs.15372.Google Scholar
Ralls, F, Cutchen, L. A contemporary review of obstructive sleep apnea. Curr Opin Pulm Med. 2019;25:578–93. DOI: 10.1097/mcp.0000000000000623.Google Scholar
Thompson, C, Legault, J, Moullec, G, et al. A portrait of obstructive sleep apnea risk factors in 27,210 middle-aged and older adults in the Canadian longitudinal study on aging. Sci Rep. 2022;12:5127. DOI: 10.1038/s41598-022-08164-6.Google Scholar
Godoy, PH, Nucera, A, Colcher, AP, de-Andrade, JE, Alves, D. Screening for obstructive sleep apnea in elderly: performance of the Berlin and STOP-bang questionnaires and the Epworth sleepiness scale using polysomnography as gold standard. Sleep Sci. 2022;15:203–8. DOI: 10.5935/1984-0063.20220020.Google Scholar
Gomes, T, Benedetti, A, Lafontaine, A-L, Kimoff, RJ, Robinson, A, Kaminska, M. Validation STOP-B28, and GOAL screening tools for identification of obstructive sleep apnea in patients with Parkinson disease. J Clin Sleep Med. 2023;19:45–54. DOI: 10.5664/jcsm.10262.Google Scholar
Swartz, RH, Cayley, ML, Lanctôt, KL, et al. The “DOC” screen: feasible and valid screening for depression, obstructive sleep apnea (OSA) and cognitive impairment in stroke prevention clinics. PLoS One. 2017;12:e0174451. DOI: 10.1371/journal.pone.0174451.Google Scholar
Katzan, IL, Thompson, NR, Uchino, K, Foldvary-Schaefer, N. A screening tool for obstructive sleep apnea in cerebrovascular patients. Sleep Med. 2016;21:70–6. DOI: 10.1016/j.sleep.2016.02.001.Google Scholar
Xie, C, Zhu, R, Tian, Y, Wang, K. Association of obstructive sleep apnoea with the risk of vascular outcomes and all-cause mortality: a meta-analysis. BMJ Open. 2017;7:e013983. DOI: 10.1136/bmjopen-2016-013983.Google Scholar
Young, T, Palta, M, Dempsey, J, Peppard, PE, Nieto, FJ, Hla, KM. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin sleep cohort study. WMJ. 2009;108:246–9.Google Scholar
Crosta, F, Desideri, G, Marini, C. Obstructive sleep apnea syndrome in Parkinson’s disease and other parkinsonisms. Funct Neurol. 2017;32:137–41. DOI: 10.11138/fneur/2017.32.3.137.Google Scholar
De Cock, VC, Abouda, M, Leu, S, et al. Is obstructive sleep apnea a problem in Parkinson’s disease? Sleep Med. 2010, 11:247–52.Google Scholar
Maggi, G, Giacobbe, C, Iannotta, F, Santangelo, G, Vitale, C. Prevalence and clinical aspects of obstructive sleep apnea in Parkinson disease: a meta-analysis. Eur J Neurol. 2024;31:e16109. DOI: 10.1111/ene.16109.Google Scholar
Jeon, SH, Hwang, YS, Oh, SY, et al. Bidirectional association between Parkinson’s disease and obstructive sleep apnea: a cohort study. J Clin Sleep Med. 2023;19:1615–23. DOI: 10.5664/jcsm.10596.Google Scholar
Neikrug, AB, Liu, L, Avanzino, JA, et al. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. Sleep. 2014;37:177–85. DOI: 10.5665/sleep.3332.Google Scholar
Emamian, F, Khazaie, H, Tahmasian, M, et al. The association between obstructive sleep apnea and alzheimer’s disease: a meta-analysis perspective. Front Aging Neurosci. 2016;8:78. DOI: 10.3389/fnagi.2016.00078.Google Scholar
Osorio, RS, Gumb, T, Pirraglia, E, et al. Sleep-disordered breathing advances cognitive decline in the elderly. Neurology. 2015;84:1964–71. DOI: 10.1212/wnl.0000000000001566.Google Scholar
Cooke, JR, Ayalon, L, Palmer, BW, et al. Sustained use of CPAP slows deterioration of cognition, sleep, and mood in patients with Alzheimer’s disease and obstructive sleep apnea: a preliminary study. JClinSleep Med. 2009;5:305–9.Google Scholar
Gaines, J, Vgontzas, AN, Fernandez-Mendoza, J, Bixler, EO. Obstructive sleep apnea and the metabolic syndrome: the road to clinically-meaningful phenotyping, improved prognosis, and personalized treatment. Sleep Med Rev. 2018;42:211–9. DOI: 10.1016/j.smrv.2018.08.009.Google Scholar
Jorge, C, Benítez, I, Torres, G, et al. The STOP-bang and Berlin questionnaires to identify obstructive sleep apnoea in Alzheimer’s disease patients. Sleep Med. 2019;57:15–20. DOI: 10.1016/j.sleep.2019.01.033.Google Scholar
Kolotkin, RL, LaMonte, MJ, Walker, JM, Cloward, TV, Davidson, LE, Crosby, RD. Predicting sleep apnea in bariatric surgery patients. Surg Obes Relat Dis. 2011;7:605–10. DOI: 10.1016/j.soard.2011.04.226.Google Scholar
Duarte, RL, Magalhães-da-Silveira, FJ. Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography. J Bras Pneumol. 2015;41:440–8. DOI: 10.1590/s1806-37132015000000027.Google Scholar
Sobreira-Neto, MA, Pena-Pereira, MA, Sobreira, EST, et al. High frequency of sleep disorders in parkinson’s disease and its relationship with quality of life. Eur Neurol. 2017;78:330–7. DOI: 10.1159/000481939.Google Scholar
PHAC. What is the impact of sleep apnea on Canadians? Fast facts from the 2009 Canadian Community Health Survey — sleep apnea rapid response. Ottawa: Public Health Agency of Canada;2010. Available: www.phac-aspc.gc.ca/cd-mc/sleepapnea-apneesommeil/pdf/sleep-apnea.pdf. Accessed September 10, 2022.Google Scholar
Karunanayake, CP, Rennie, DC, Hagel, L, et al. Access to specialist care in rural saskatchewan: the Saskatchewan rural health study. Healthcare (Basel). 2015;3:84–99. DOI: 10.3390/healthcare3010084.Google Scholar
Raina, P, Wolfson, C, Kirkland, S, et al. Cohort profile: the Canadian longitudinal study on aging (CLSA). Int J Epidemiol. 2019;48:1752–3j. DOI: 10.1093/ije/dyz173.Google Scholar