Effects of sleep-disordered breathing and hypertension on cognitive function in elderly adults
Effects of sleep-disordered breathing and hypertension on cognitive function in elderly adults
复制标题
DOI：
10.1080/10641963.2019.1632338
复制
发表时间：
2019-07-05
影响因子：
12.3
通讯作者：
Ozaki，Norio
中科院分区：
文献类型：
--
作者：
Kato，Kazuko;Noda，Akiko;Ozaki，Norio
睡眠主诉在老年人中很常见[1]。衰老与睡眠数量和组成的生理变化有关，但老年睡眠也受到共病和昼夜节律变化的影响。合并症在决定睡眠不满意方面发挥着重要作用，因为老年典型的慢性病可能直接影响睡眠(即症状可能干扰睡眠启动或导致夜间觉醒)，也可能通过药物的间接影响而间接影响睡眠。老年人睡眠障碍的影响在性质上类似于其他年龄段的人，但在临床环境中可能很难识别和解释[2]。睡眠不足或睡眠质量差会导致白天困倦、注意力下降或记忆问题；在老年受试者中，这些症状或体征可被解释为痴呆症和/或认知改变。与嗜睡有关的反应时间延迟会增加驾驶事故或与跌倒相关的骨折的风险。最后，减少对家庭或社会生活的参与可能会造成不充分的感觉和健康状况不佳的感觉，随之而来的是资源利用率高和医疗费用增加的趋势[1，2]。老年人经常表现出睡眠呼吸障碍(SDB)，即打鼾症和阻塞性和中枢性睡眠呼吸暂停，但他们的症状和后果与年轻人观察到的有所不同，导致了这样的假设，尽管有明显的相似之处，SDB在非老年人和老年成人受试者中可能代表不同的疾病[3]。本章将在老年人群中简要描述：a)阻塞性睡眠呼吸暂停(OSA)的特征；b)SDB在慢性心力衰竭中的患病率和可能的作用；c)慢性阻塞性肺疾病(COPD)的睡眠改变。最后，将对糖尿病和中风的SDB的特点进行简要总结。
Sleep complaints are common in elderly subjects [1]. Ageing is associated with physiological changes in the amount and composition of sleep, but sleep in old age is also affected by comorbidities and alterations in circadian rhythms. Comorbidities play a major role in determining unsatisfactory sleep, since chronic diseases typical of advanced age may affect sleep either directly (ie symptoms can interfere with sleep initiation or cause nocturnal awakenings) or indirectly, through collateral effects of drugs. The effects of sleep disturbances in elderly subjects are qualitatively similar to those occurring at other ages, but can be hard to recognise and interpret in the clinical context [2]. Insufficient or qualitatively poor sleep can cause daytime sleepiness, decreased attention or memory problems; in old subjects, these symptoms or signs can be interpreted as indicating dementia and/or cognitive alterations. A sleepiness-related delay in reaction time can increase the risk of driving accidents or fall-associated fractures. Finally, reduced participation in family or social life can cause feelings of inadequacy and the perception of a poor health status, with the subsequent trend to high resource utilisation and increased health costs [1, 2]. Elderly people often exhibit sleep-disordered breathing (SDB), ie snoring and obstructive and central sleep apnoea, but their symptoms and the consequences are somewhat different compared with those observed in younger adults, leading to the hypothesis that despite obvious similarities, SDB may represent different diseases in non-elderly and elderly adult subjects [3]. This chapter will briefly describe in the elderly population: a) the characteristics of obstructive sleep apnoea (OSA); b) the prevalence and possible role of SDB in chronic heart failure; and c) the alterations in sleep in chronic obstructive pulmonary disease (COPD). Finally, the features of SDB in diabetes, and stroke will be summarised briefly.