scholarly journals Amelioration of sleep-disordered breathing with supplemental oxygen in older adults

2020 ◽  
Vol 129 (6) ◽  
pp. 1441-1450
Author(s):  
Ruchi Rastogi ◽  
M. S. Badr ◽  
A. Ahmed ◽  
S. Chowdhuri
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Sleep Disordered Breathing ◽  
Supplemental Oxygen ◽  
Vulnerable Population ◽  
Central Apnea ◽  
Elderly Adults ◽  
Chemoreflex Sensitivity ◽  
Central Apneas ◽  
First Time

This study demonstrates for the first time in elderly adults without heart disease that intervention with supplemental oxygen in the clinical range will ameliorate central apneas and hypopneas by decreasing the propensity to central apnea through decreased chemoreflex sensitivity, even in the absence of a reduction in the plant gain. Thus, the study provides physiological evidence for use of supplemental oxygen as therapy for mild-to-moderate SDB in this vulnerable population.

scholarly journals Aging is associated with increased propensity for central apnea during NREM sleep

2018 ◽  
Vol 124 (1) ◽  
pp. 83-90 ◽  
Author(s):  
Susmita Chowdhuri ◽  
Sukanya Pranathiageswaran ◽  
Hillary Loomis-King ◽  
Anan Salloum ◽  
M. Safwan Badr
Keyword(s):  
Carbon Dioxide ◽  
Older Adults ◽  
Young Adults ◽  
Nrem Sleep ◽  
The Elderly ◽  
Central Apnea ◽  
Elderly Adults ◽  
Rapid Eye Movement Sleep ◽  
Controller Gain ◽  
Central Apneas

The reason for increased sleep-disordered breathing with predominance of central apneas in the elderly is unknown. We hypothesized that the propensity to central apneas is increased in older adults, manifested by a reduced carbon-dioxide (CO2) reserve in older compared with young adults during non-rapid eye movement sleep. Ten elderly and 15 young healthy adults underwent multiple brief trials of nasal noninvasive positive pressure ventilation during stable NREM sleep. Cessation of mechanical ventilation (MV) resulted in hypocapnic central apnea or hypopnea. The CO2 reserve was defined as the difference in end-tidal CO2 ([Formula: see text]) between eupnea and the apneic threshold, where the apneic threshold was [Formula: see text] that demarcated the central apnea closest to the eupneic [Formula: see text]. For each MV trial, the hypocapnic ventilatory response (controller gain) was measured as the change in minute ventilation (V̇e) during the MV trial for a corresponding change in [Formula: see text]. The eupneic [Formula: see text] was significantly lower in elderly vs. young adults. Compared with young adults, the elderly had a significantly reduced CO2 reserve (−2.6 ± 0.4 vs. −4.1 ± 0.4 mmHg, P = 0.01) and a higher controller gain (2.3 ± 0.2 vs. 1.4 ± 0.2 l·min−1·mmHg−1, P = 0.007), indicating increased chemoresponsiveness in the elderly. Thus elderly adults are more prone to hypocapnic central apneas owing to increased hypocapnic chemoresponsiveness during NREM sleep. NEW & NOTEWORTHY The study describes an original finding where healthy older adults compared with healthy young adults demonstrated increased breathing instability during non-rapid eye movement sleep, as suggested by a smaller carbon dioxide reserve and a higher controller gain. The findings may explain the increased propensity for central apneas in elderly adults during sleep and potentially guide the development of pathophysiology-defined personalized therapies for sleep apnea in the elderly.

Hypercapnia-Induced Vasodilation in the Cerebral Circulation is Reduced in Older Adults with Sleep Disordered Breathing

2021 ◽  
Author(s):  
Ruchi Rastogi ◽  
Barbara J. Morgan ◽  
M. Safwan Badr ◽  
Susmita Chowdhuri
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Vascular Function ◽  
Sleep Disordered Breathing ◽  
Age Groups ◽  
Central Apneas ◽  
Cerebral Vasodilation ◽  
End Tidal ◽  
Cerebral Vascular ◽  
Disordered Breathing

The prevalence of sleep disordered breathing (SDB) is higher in older adults compared to young individuals. The increased propensity for ventilatory control instability in older adults may contribute to the increased prevalence of central apneas. Reductions in the cerebral vascular response to CO2 may exacerbate ventilatory overshoots and undershoots during sleep. Thus, we hypothesized that hypercapnia-induced cerebral vasodilation (HCVD) will be reduced in older vs. young adults. In 11 older and 10 young adults with SDB, blood flow velocity in the middle cerebral artery (MCAV) was measured using Doppler transcranial ultrasonography, during multiple steady state hyperoxic hypercapnic breathing trials while awake, interspersed with room air breathing. Changes in ventilation, MCAV and mean arterial pressure (MAP) via finger plethysmography during the trials were compared with baseline eupneic values. For each hyperoxic hypercapnic trial, the change (Δ) in MCAV for a corresponding change in end-tidal CO2 and the HCVD or the change in cerebral vascular conductance (MCAV divided by MAP) for a corresponding change in end-tidal CO2 were determined. The hypercapnic ventilatory response was similar between the age groups, as was ΔMCAV/ΔPETCO2. However, compared with young, older adults had a significantly smaller HCVD (1.3 ± 0.7 vs. 2.1 ± 0.6 units/mmHg, p=0.004). Multivariable analyses demonstrated that age and nadir oxygen saturation during nocturnal polysomnography were significant predictors of HCVD. Thus, our data indicate that older age and SDB-related hypoxia are associated with diminished HCVD. We hypothesize that this impairment in vascular function may contribute to breathing instability during sleep in these individuals.

scholarly journals Evaluation of the efficacy of hearing aids in older adults: a multiparametric longitudinal study protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Domenico Cuda ◽  
Sara Ghiselli ◽  
Alessandra Murri
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Speech Perception ◽  
Hearing Aids ◽  
Assessment Tools ◽  
Elderly Subjects ◽  
Single Subject ◽  
Measurement Tools ◽  
First Time

Abstract Background Prevalence of hearing loss increases with age. Its estimated prevalence is 40–50 % in people over 75 years of age. Recent studies agree that declinein hearing threshold contribute to deterioration in sociality, sensitivity, cognition, and quality of life for elderly subjects. The aim of the study presented in this paper is to verify whether or not rehabilitation using first time applied Hearing Aids (HA) in a cohort of old people with hearing impairment improves both speech perception in a noisy environment over time and the overall health-related quality of life. Methods The monocentric, prospective, repeated measurements, single-subject, clinical observational study is to recruit 100 older adults, first-time HA recipients (≥ 65 years).The evaluation protocol is designed to analyze changes in specific measurement tools a year after the first HA usage in comparison with the evaluation before HA fitting. Evaluations will consist of multiparametric details collected through self-report questionnaires completed by the recipients and a series of commonly used audiometric measures and geriatric assessment tools. The primary indicator of changes in speech perception in noise to be used is the Italian version of Oldenburg Satz (OLSA) test whereas the indicator of changes in overall quality of life will be the Assessment of Quality of Life (AQoL) and Hearing Handicap Inventory for the Elderly (HHIE) questionnaires. The Montreal Cognitive Assessment (MoCA) will help in screening the cognitive state of the subjects. Discussion The protocol is designed to make use of measurement tools that have already been applied to the hearing-impaired population in order to compare the effects of HA rehabilitation in the older adults immediately before first HA usage (Pre) and after 1 year of experience (Post). This broad approach will lead to a greater understanding of how useful hearing influences the quality of life in older individuals, and therefore improves potentials for healthy aging. The data is to be analyzed by using an intrasubject endpoint comparison. Outcomes will be described and analyzed in detail. Trial registration This research was retrospectively registered underno. NCT04333043at ClinicalTrials.gov (http://www.clinicaltrials.gov/) on the 26 March 2020. This research has been registered with the Ethics Committee of the Area Vasta Emilia Nord under number 104, date of approval 17/07/2017.

Dental Care Use, Edentulism, and Systemic Health among Older Adults

2021 ◽  
pp. 002203452110190
Author(s):  
C.D. Meyerhoefer ◽  
J.V. Pepper ◽  
R.J. Manski ◽  
J.F. Moeller
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Chronic Illness ◽  
Dental Care ◽  
Fixed Effects ◽  
Past Research ◽  
Positive Correlations ◽  
Systemic Health ◽  
Time Invariant ◽  
Retirement Study

Past research suggests there are systematic associations between oral health and chronic illness among older adults. Although causality has not yet been credibly established, periodontitis has been found to be associated with higher risk of both heart disease and stroke. We advance this literature by estimating the direct association between dental care use and systemic health using multiple waves of the 1992 to 2016 Health and Retirement Study. Through the inclusion of individual fixed effects in our regression models, we account for unobservable time-invariant characteristics of individuals that might otherwise bias estimates of the association between dental care use and health. We find statistically significant negative associations between dental care use and the number of health conditions, self-reported overall health, the incidence of heart disease, and the incidence of stroke. In particular, the use of dental care within the past 2 y is associated with a 2.7% reduction in the likelihood of being diagnosed with a heart condition and a reduction in the likelihood of a stroke diagnosis of between 5.3% and 11.6%. We also find large positive correlations between edentulism and the measures of chronic illness. Associations from models estimated separately for men and women are qualitatively similar to one another. These findings provide additional motivation for the consideration of a Medicare dental benefit.

scholarly journals The clinical value of ficolin-3 gene polymorphism in rheumatic heart disease. An Egyptian adolescents study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Maher H. Gomaa ◽  
Emad Gamil Khidr ◽  
Ahmed Elshafei ◽  
Hala S. Hamza ◽  
Aya M. Fattouh ◽  
...  
Keyword(s):  
Innate Immunity ◽  
Heart Disease ◽  
Gene Polymorphism ◽  
Rheumatic Heart Disease ◽  
Streptococcus Pyogenes ◽  
Gene Polymorphisms ◽  
Clinical Value ◽  
Homozygous Genotype ◽  
First Time ◽  
Rheumatic Heart

Abstract Objective Ficolin-3 is one of the innate immunity molecules that was thought to play a pivotal role in Streptococcus pyogenes autoimmunity and its complications; rheumatic fever (RF) and rheumatic heart disease (RHD). We aimed to disclose if there is an association between ficolin-3 (FCN3) gene polymorphisms (rs4494157 and rs10794501) and RF with or without RHD for the first time in Egyptian adolescents. Results Serum ficolin-3 level was significantly elevated in patients suffering from RF with and without RHD in comparison with control. Regarding FCN3 gene (rs4494157) polymorphism, a significant correlation was found between the A allele and the susceptibility to RF with or without RHD (OR = 2.93, P = 0.0002 and OR = 2.23, P = 0.008 respectively). Besides, AA homozygous genotype showed a significant association with RHD risk (OR = 3.47, P = 0.026). Patients carrying the A allele (CA + AA) had significantly higher serum ficolin-3 than those carrying the CC genotype (P ˂ 0.0001). While the frequency of (rs10794501) polymorphism revealed no significant differences between the controls and RF patients with or without RHD (OR = 1.43, P = 0.261 and OR = 1.48, P = 0.208 respectively).

scholarly journals Sleep-Disordered Breathing Is Associated With Impaired Odor Identification in Older U.S. Adults

2020 ◽  
Author(s):  
Jesse K Siegel ◽  
Xiandao Yuan ◽  
Kristen E Wroblewski ◽  
Martha K McClintock ◽  
Jayant M Pinto
Keyword(s):  
Older Adults ◽  
Central Nervous System ◽  
Nervous System ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Sleep Disordered Breathing ◽  
Odor Identification ◽  
Odor Sensitivity ◽  
Disordered Breathing

Abstract Background Sleep-disordered breathing (SDB) is a common, underdiagnosed condition in older adults with major health consequences, including disrupted central nervous system functioning. Whether SDB may affect sensory function is unclear. We sought to address this question by comparing 2 forms of olfactory testing which measure peripheral and central olfactory processing. Methods We assessed SDB (survey-reported snoring frequency, nighttime apneic events, or diagnosis of sleep apnea) in the National Social Life, Health, and Aging Project, a nationally representative sample of older U.S. adults. Odor sensitivity (peripheral) and odor identification (central) were assessed with validated instruments. Logistic regression was used to test the relationship between SDB and olfaction, accounting for relevant covariates, including demographics, cognition, and comorbidity. Results Twenty-nine percent of older U.S. adults reported symptoms of SDB (apneic events or nightly snoring). Of these, only 32% had been diagnosed with sleep apnea. Older adults with SDB (those who reported symptoms or have been diagnosed with sleep apnea) were significantly more likely to have impaired odor identification (odds ratio 2.13, 95% confidence interval 1.19–3.83, p = .012) in analyses that accounted for age, gender, race/ethnicity, education, cognition, comorbidities (including depression), and body mass index. Presence of SDB was not associated with impaired odor sensitivity (odds ratio 1.03, 95% confidence interval 0.75–1.43, p = .84). Conclusion SDB is highly prevalent but underdiagnosed in older U.S. adults and is associated with impaired odor identification but not odor sensitivity. These data support the concept that SDB affects pathways in the central nervous system which involve chemosensory processing.

scholarly journals Tailoring interventions for social isolation among older persons during the COVID-19 pandemic: challenges and pathways to healthcare equity

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Lise Dassieu ◽  
Nadia Sourial
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Social Isolation ◽  
Older Persons ◽  
Vulnerable Population ◽  
Subjective Experiences ◽  
Main Text ◽  
Healthcare Equity ◽  
Structural Inequities

Abstract Background Social isolation among older adults raises major issues for equity in healthcare in the context of the COVID-19 pandemic. Main text This commentary describes current challenges in preventing social isolation among older adults and proposes pathways to develop inclusive approaches to intervention in this vulnerable population. Building interventions that take account of structural inequities among older persons, as well as their subjective experiences, expectations and perspectives, appears fundamental to improve their health and quality of life in pandemic and post-pandemic contexts. Conclusions We argue that equity-based and person-centered approaches are critical to counter the negative outcomes of social isolation in the vulnerable older population.

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