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Comparison of Sleep Apnea Questionnaires and Reported Diagnosis in Neurological Disorders of Aging

Published online by Cambridge University Press:  17 May 2024

Teresa Gomes Open the ORCID record for Teresa Gomes [Opens in a new window] ,
Andrea Benedetti ,
Ron Postuma ,
Dorrie Rizzo ,
Marc Baltzan ,
Richard John Kimoff  and
Marta Kaminska Open the ORCID record for Marta Kaminska [Opens in a new window]
Teresa Gomes
Affiliation:
Department of Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
Andrea Benedetti
Affiliation:
Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada Department of Medicine and Department of Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, QC, Canada
Ron Postuma
Affiliation:
Department of Neurology and Neurosurgery, McGill University, Montreal General Hospital, Montreal, QC, Canada
Dorrie Rizzo
Affiliation:
Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
Marc Baltzan
Affiliation:
Mount Sinai Hospital Center, Montreal, QC, Canada
Richard John Kimoff
Affiliation:
Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
Marta Kaminska*
Affiliation:
Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada Respiratory Division and Sleep Laboratory, McGill University Health Centre, Montreal, QC, Canada
*
Corresponding author: M. Kaminska; Email: [email protected]
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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 :

RÉSUMÉ :

Comparaison entre des questionnaires portant sur l’apnée du sommeil et les diagnostics rapportés dans le cas de troubles neurologiques du vieillissement

Contexte :

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.

Méthodes :

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).

Résultats :

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.

Conclusions :

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.

Keywords

comparisonelderlyneurological disorderobstructive sleep apneaquestionnairescreening
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 52 , Issue 2 , March 2025 , pp. 269 - 275
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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