본문 바로가기
KERD
논문KCI 등재

노인 폐쇄성수면무호흡증 환자에서의 양압기 치료 전략

Continuous Positive Airway Pressure Treatment in Elderly Patients With Obstructive Sleep Apnea

김세원
대한수면의학회 (Korean Academy of Sleep Medicine)|2023.12|수면정신생리 (Sleep Medicine and Psychophysiology)|제30권 제2호|pp. 36-40|DOI 10.14401/KASMED.2023.30.2.36

0

조회

0

다운로드

0

인용

0

참고문헌

키워드

노화AgingObstructive sleep apnea syndrome양압기순응도Continuous positive airway pressure폐쇄성수면무호흡증수면호흡장애Sleep related breathing disorder.
주제분류정신과학

초록

노인 폐쇄성수면무호흡증 환자에 대한 양압기 치료 전략 은 고령 환자의 여러 특별한 상황을 고려해야 한다. 노화로 인한 불면과 각성, 야간빈뇨, 신경정신장애, 동반 질환, 치아결손, 그리고 독거 상태 등은 양압기 치료의 어려움을 증가 시킬 수 있다. 특히, 노인 환자는 양압기 치료에 대한 교육과 관리에 더 많은 시간이 필요할 수 있다. 그러나 양압기 치료 는 고령 환자에서도 효과적이며, 수면의 질, 야뇨증, 심기능 과 신경행동적 예후의 개선을 가져올 수 있다. 고령의 나이 자체가 양압기 치료 순응도에 차이를 주지는 않았으며, 치매 환자에서도 적용이 가능하였다. 따라서, 노인 폐쇄성수면무 호흡증 환자에게 양압기 치료를 시행할 때에는 환자의 특성 과 상태를 신중히 고려하며 개별화된 접근이 필요하다.

Abstract

Obstructive sleep apnea (OSA) is prevalent among the elderly, with incidence rising due to aging trends. Clinical manifestations in the elderly differ significantly, deviating from conventional risk factors such as male gender and obesity. Postmenopausal women experience a notable surge in OSA prevalence, while traditional features like snoring and high body mass index (BMI) di¬minish. Limited evidence exists on elderly OSA progression, but untreated cases elevate stroke, cognitive decline, and heart fail¬ure risks. Continuous positive airway pressure (CPAP) emerges as the most effective treatment. CPAP therapy proves effective for elderly OSA patients, enhancing sleep quality, addressing nocturia, and improving neurobehavioral outcomes. Elderly individ¬uals often require lower CPAP pressures, with positive effects observed on cardiovascular risk factors and neurobehavioral dis¬orders. Overcoming challenges like nocturnal awakenings and comorbidities, age does not significantly impact PAP adherence. Education, troubleshooting, and emphasizing therapy benefits are vital. Addressing adherence factors in the elderly, including depression, is pivotal. Individualized strategies, considering aging-related challenges and comorbidities, are imperative for suc¬cessful PAP treatment in this population. Despite potential hurdles, PAP therapy remains a valuable intervention, even for those with dementia.

참고문헌 (58)

  1. Alajmi M, "Impact of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea hypopnea : a meta-analysis of randomized controlled trials", Lung, 185, pp.67~72 (2007)
  2. Aloia MS, "Improving compliance with nasal CPAP and vigilance in older adults with OAHS", Sleep Breath, 5, pp.13~21 (2001)
  3. Aloia MS, "Neuropsychological changes and treatment compliance in older adults with sleep apnea", J Psychosom Res, 54, pp.71~76 (2003)
  4. Ancoli-Israel S, "Sleep-disordered breathing in community-dwelling elderly", Sleep, 14, pp.486~495 (1991)
  5. Ayalon L, "Adherence to continuous positive airway pressure treatment in patients with Alzheimer’s disease and obstructive sleep apnea", Am J Geriatr Psychiatry, 14, pp.176~180 (2006)
  6. Barbé F, "Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea : a randomized controlled trial", JAMA, 307, pp.2161~2168 (2012)
  7. Berry DT, "Nocturnal hypoxia and neuropsychological variables", J Clin Exp Neuropsychol, 8, pp.229~238 (1986)
  8. Bixler EO, "Prevalence of sleep-disordered breathing in women : effects of gender", Am J Respir Crit Care Med, 163, pp.608~613 (2001)
  9. Bliwise DL, "Risk factors for sleep disordered breathing in heterogeneous geriatric populations", J Am Geriatr Soc, 35, pp.132~141 (1987)
  10. Chai-Coetzer CL, "Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study", Sleep, 36, pp.1929~1937 (2013)
  11. Dempsey JA, "Pathophysiology of sleep apnea", Physiol Rev, 90, pp.47~112 (2010)
  12. Drager LF, "Sleep apnea and cardiovascular disease : lessons from recent trials and need for team science", Circulation, 136, pp.1840~1850 (2017)
  13. Driver HS, "The influence of the menstrual cycle on upper airway resistance and breathing during sleep", Sleep, 28, pp.449~456 (2005)
  14. Eckert DJ, "Pathophysiology of adult obstructive sleep apnea", Proc Am Thorac Soc, 5, pp.144~153 (2008)
  15. Endeshaw Y, "Clinical characteristics of obstructive sleep apnea in community-dwelling older adults", J Am Geriatr Soc, 54, pp.1740~1744 (2006)
  16. Fitzgerald MP, "Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment", Am J Obstet Gynecol, 194, pp.1399~1403 (2006)
  17. Gaisl T, "Efficacy of pharmacotherapy for OSA in adults : a systematic review and network meta-analysis", Sleep Med Rev, 46, pp.74~86 (2019)
  18. Gottlieb DJ, "Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure : the sleep heart health study", Circulation, 122, pp.352~360 (2010)
  19. Grote L, "Sleeprelated breathing disorder is an independent risk factor for systemic hypertension", Am J Respir Crit Care Med, 160, pp.1875~1882 (1999)
  20. Guilleminault C, "A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia", J Psychosom Res, 56, pp.511~515 (2004)
  21. Guilleminault C, "Determinants of daytime sleepiness in obstructive sleep apnea", Chest, 94, pp.32~37 (1988)
  22. Guillot M, "Association between severe obstructive sleep apnea and incident arterial hypertension in the older people population", Sleep Med, 14, pp.838~842 (2013)
  23. Hoch CC, "Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life", Sleep, 13, pp.502~511 (1990)
  24. Javaheri S, "Sleep apnea : types, mechanisms, and clinical cardiovascular consequences", J Am Coll Cardiol, 69, pp.841~858 (2017)
  25. Kaynak H, "Does frequency of nocturnal urination reflect the severity of sleep-disordered breathing?", J Sleep Res, 13, pp.173~176 (2004)
  26. Kezirian EJ, "Behavioral correlates of sleep-disordered breathing in older women", Sleep, 30, pp.1181~1188 (2007)
  27. Kim H, "Obstructive sleep apnea as a risk factor for cerebral white matter change in a middle-aged and older general population", Sleep, 36, pp.709b~715b (2013)
  28. Kostikas K, "The determinants of therapeutic levels of continuous positive airway pressure in elderly sleep apnea patients", Respir Med, 100, pp.1216~1225 (2006)
  29. Kushida CA, "Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders", Sleep, 29, pp.375~380 (2006)
  30. Kushida CA, "Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances : an update for 2005", Sleep, 29, pp.240~243 (2006)
  31. Lewis KE, "Early predictors of CPAP use for the treatment of obstructive sleep apnea", Sleep, 27, pp.134~138 (2004)
  32. Marshall NS, "Sleep apnea as an independent risk factor for all-cause mortality : the busselton health study", Sleep, 31, pp.1079~1085 (2008)
  33. Martínez-García MA, "Cardiovascular mortality in obstructive sleep apnea in the elderly : role of long-term continuous positive airway pressure treatment : a prospective observational study", Am J Respir Crit Care Med, 186, pp.909~916 (2012)
  34. Martinez-Garcia MA, "Continuous positive airway pressure adherence declines with age in elderly obstructive sleep apnoea patients", ERJ Open Res, 5 (2019)
  35. Martínez-García, MÁ, "Obstructive sleep apnoea in the elderly : role of continuous positive airway pressure treatment", Eur Respir J, 46, pp.142~151 (2015)
  36. Mazza S, "Most obstructive sleep apnoea patients exhibit vigilance and attention deficits on an extended battery of tests", Eur Respir J, 25, pp.75~80 (2005)
  37. McMillan A, "Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome(PREDICT) : a 12-month, multicentre, randomised trial", Lancet Respir Med, 2, pp.804~812 (2014)
  38. Munoz R, "Severe sleep apnea and risk of ischemic stroke in the elderly", Stroke, 37, pp.2317~2321 (2006)
  39. Naëgelé B, "Deficits of cognitive executive functions in patients with sleep apnea syndrome", Sleep, 18, pp.43~52 (1995)
  40. Nigam G, "A systematic review on prevalence and risk factors associated with treatment-emergent central sleep apnea", Ann Thorac Med, 11, pp.202~210 (2016)
  41. Parra O, "Early treatment of obstructive apnoea and stroke outcome : a randomised controlled trial", Eur Respir J, 37, pp.1128~1136 (2011)
  42. Peker Y, "Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea : a 7-year follow-up", Am J Respir Crit Care Med, 166, pp.159~165 (2002)
  43. Pelletier-Fleury N, "The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox’s proportional hazard analysis", Sleep Med, 2, pp.225~232 (2001)
  44. Phoha RL, "Preliminary longitudinal assessment of sleep in the elderly", Sleep, 13, pp.425~429 (1990)
  45. Punjabi NM, "Sleep-disordered breathing and mortality : a prospective cohort study", PLoS Med, 6, pp.e1000132~ (2009)
  46. Redline S, "Sleep-disordered breathing in Hispanic", Latino individuals of diverse backgrounds. The hispanic community health study, Am J Respir Crit Care Med, pp.2014, 189[DOI]
  47. Russo-Magno P, "Compliance with CPAP therapy in older men with obstructive sleep apnea", J Am Geriatr Soc, 49, pp.1205~1211 (2001)
  48. Senaratna CV, "Prevalence of obstructive sleep apnea in the general population : a systematic review", Sleep Med Rev, 34, pp.70~81 (2017)
  49. Somers VK, "Sleep apnea and cardiovascular disease : an American Heart Association", American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing, 2008, pp.52, 686~717
  50. Tishler PV, "Incidence of sleep-disordered breathing in an urban adult population : the relative importance of risk factors in the development of sleepdisordered breathing", JAMA, 289, pp.2230~2237 (2003)
  51. Tufik S, "Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study", Sleep Med, 11, pp.441~446 (2010)
  52. Weaver TE, "Continuous positive airway pressure treatment for sleep apnea in older adults", Sleep Med Rev, 11, pp.99~111 (2007)
  53. Yaffe K, "Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women", JAMA, 306, pp.613~619 (2011)
  54. Yang MC, "Factors affecting CPAP acceptance in elderly patients with obstructive sleep apnea in Taiwan", Respir Care, 58, pp.1504~1513 (2013)
  55. Young T, "Burden of sleep apnea : rationale, design, and major findings of the Wisconsin Sleep Cohort study", WMJ, 108, pp.246~249 (2009)
  56. Young T, "Epidemiology of obstructive sleep apnea : a population health perspective", Am J Respir Crit Care Med, 165, pp.1217~1239 (2002)
  57. Young T, "Predictors of sleep-disordered breathing in communitydwelling adults : the Sleep Heart Health Study", Arch Intern Med, 162, pp.893~900 (2002)
  58. Zinchuk A, "Phenotypic subtypes of OSA : a challenge and opportunity for precision medicine", Chest, 157, pp.403~420 (2020)

관련 논문AI추천

다양한 폐쇄성수면무호흡증 환자에서의 양압기 치료김세원대한수면의학회 · 수면정신생리2023 · 제30권 제2호노인 수면 무호흡증：임상 양상, 진단 그리고 치료신홍범대한노인정신의학회 · 노인정신의학2010 · 제14권 제2호성인 폐쇄수면무호흡의 치료 개괄양광익, 선우준상대한수면연구학회 · Journal of sleep medicine2017 · 제14권 제1호폐쇄성수면무호흡증에서 포괄적 개별 맞춤형 중재를 통한 지속적상기도양압술 순응도 향상 평가 연구오단아, 윤지은, 윤창호, 이우진, 황인하대한수면연구학회 · Journal of sleep medicine2023 · 제20권 제1호건강 보험 적용하에 장기적으로 양압기 치료를 했던 폐쇄성 수면무호흡증 환자에서 중단 요인 분석김성동, 김현수, 박지환, 장서윤, 조규섭, 조현주대한이비인후과학회 부산,울산,경남 지부회 · 임상이비인후과2023 · 제34권 제2호폐쇄성 수면무호흡증 환자에서 양압기 치료에 대한 1년 이상 순응군과 비순응군의 비교금상연, 박진우, 박희준, 신승헌, 예미경, 유재호대한이비인후과학회 부산,울산,경남 지부회 · 임상이비인후과2022 · 제33권 제3호

이 간행물의 다른 논문 (4건)

다양한 폐쇄성수면무호흡증 환자에서의 양압기 치료김세원pp. 29-29폐쇄성 폐질환과 동반된 폐쇄수면무호흡증의 치료김성수, 박순민pp. 30-35소아 폐쇄성 수면 무호흡에서 지속기도양압기 치료강은경pp. 41-45수면 중 주기성 사지운동의 원인 및 병태생리서민철pp. 46-56
원문 보기