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

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Table of contents

Goal of the pilot study Background Methods Results Discussion Conclusion

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Goal of the Pilot Study

• Prevalence of OSAHS in elderly patients with insomnia

• Validity and practical feasibility of questionnaires

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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

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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

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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®)

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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

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Methods

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Methods

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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!

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Methods

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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

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Methods

• Home visito Questionnaires

• PSQI• ESS• Berlin questionnaire• STOP-BANG

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Methods: Brizzy®

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Methods: JAWAC

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Results

• Brizzy® report

• Patient characteristics

• Brizzy® analyses

• Questionnaires

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Brizzy® report

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Results: Patient characteristics

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Results:Brizzy ® reports

A small example….

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

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Results:Questionnaires mean scores and statistic significance

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

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

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Discussion

• Strenghts o Uniformo First step in an unexplored domain

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

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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

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THANKS FOR YOUR ATTENTION

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Any questions?