Obstructive sleep apnea (OSA) is often undiagnosed and unaddressed in adults ages 50 and over, a study led by a University of Florida College of Medicine researcher suggests.

The study, published in Annals of the American Thoracic Society, reveals a need to identify strategies that could address this inequity nationally, according to lead author Christopher Kaufmann, PhD, MHS, an assistant professor in the college’s department of health outcomes and biomedical informatics, in a release. 

“That we’re finding undiagnosed and thus untreated obstructive sleep apnea in this population is especially concerning,” says Kaufmann, who is also a faculty member in the UF Institute on Aging, in the release. “Older adults have greater risk for many different adverse health outcomes.”

Kaufmann and his collaborators used data from more than 9,000 adults ages 50 and older from the 2016 Health and Retirement Study, a nationally representative sample of older adults in the United States. That study reported a variety of characteristics in participants, including the presence of OSA; treatment history, if any; socioeconomic status; symptoms of sleep apnea; and demographics.

“We are increasingly recognizing that health disparities in sleep apnea are not just related to the structure of the face and skull and obesity,” says Atul Malhotra, MD, a professor in the division of pulmonary, critical care, and sleep medicine at the University of California, San Diego, and the study’s senior author, in a release. “Environmental factors such as diet, exercise, and air pollution may also contribute.”

The study found potentially undiagnosed older adults with OSA were more likely to be a member of a minority/ethnic racial group; have less education; lower income; lack health insurance; and to be male. That is compared with older adults who had been diagnosed and treated.

The study found those without insurance had a 90% higher risk of potentially undiagnosed OSA.

Researchers found the overwhelming majority, or 6,908 people, were rated as having possible undiagnosed OSA. And a small—yet significant—number, about 1,000 more, had been diagnosed with OSA but were not getting treatment.

One potential risk in an older population, Kaufmann notes, is that people who have OSA are at higher risk for cognitive decline.

A variety of factors can cause or contribute to OSA. Obesity, older age, diabetes, asthma, and other characteristics heighten the risk. Untreated OSA can reduce life expectancy as it causes complications such as cardiovascular issues, daytime fatigue, and cognitive issues.

“We really need to increase public awareness of obstructive sleep apnea,” Kaufmann says in the release. “We’re looking at a population that is really vulnerable to the ill effects of obstructive sleep apnea, and we have to do everything we can to make sure people are diagnosed and treated.”

But the study reveals the problem extends beyond just lack of medical coverage, as older adults age 65 and over are eligible for Medicare. The study found people often face barriers to preventive health care services, including travel distance to clinics or doctors, especially in rural locations.

As a matter of public policy, more resources need to be devoted to identifying and ultimately diagnosing obstructive sleep apnea in older adults, Kaufmann says in the release.

“Older adults are at risk for a number of negative health outcomes,” Kaufmann adds. “We have to protect them from the deleterious effects of obstructive sleep apnea. Education about the condition and the benefits of treating it needs to be a major component of these efforts so that older adults can recognize the symptoms and obtain the care they need.”

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