Drugs Aging 2003; 20 (8): 551-560 THERAPY IN PRACTICE 1170-229X/03/0008-0551/$30.00/0 © Adis Data Information BV 2003. All rights reserved. Sleep Apnoea In The Older Adult Pathophysiology, Epidemiology, Consequences And Management Tamar Shochat and Giora Pillar Sleep Lab, Technion-Israel Institute of Technology, Rambam Medical Center, Haifa, Israel Contents Abstract .................................................................................... 551 1. Pathophysiology, Epidemiology and Risk Factors ............................................ 552 1.1 Pathophysiology ..................................................................... 552 1.2 Epidemiology ....................................................................... 553 1.3 Risk Factors .......................................................................... 553 2. Consequences .......................................................................... 553 2.1 Consequences in the Older Adult ..................................................... 554 2.2 Consequences in the Demented Patient ............................................... 554 3. Management ........................................................................... 554 3.1 Medical Management ............................................................... 555 3.1.1 Continuous Positive Airway Pressure .............................................. 555 3.1.2 Weight Loss .................................................................... 556 3.1.3 Oral Appliances ............................................................... 556 3.1.4 Body Position .................................................................. 556 3.1.5 Medications ................................................................... 556 3.2 Surgical Management ............................................................... 557 3.2.1 Nasal Reconstruction ........................................................... 557 3.2.2 Pharyngeal Reconstruction ..................................................... 558 3.2.3 Genioglossus Advancement and Hyoid Myotomy ................................. 558 3.2.4 Maxillomandibular Advancement ............................................... 558 3.2.5 Tracheostomy ................................................................. 558 4. Conclusions ............................................................................. 558 Sleep apnoea is a breathing disorder in sleep usually caused by repetitive upper Abstract airway obstruction. Its primary symptoms include snoring, daytime sleepiness and decreased cognitive functioning. Risk factors for the condition include obesity, anatomical abnormalities, aging, and family history. It has been associated with hypertension, cardiovascular and pulmonary diseases and increased mortality. The prevalence of sleep apnoea increases with age, although the severity of the disorder, as well as the morbidity and mortality associated with it, may actually decrease in the elderly. A decline in cognitive functioning in older adults with sleep apnoea may resemble dementia. Medical management of sleep apnoea rarely relies on drug treatment, as the few drugs (antidepressants and respiratory stimulants) tested for treatment have been found to be ineffective, or cause tolerance or serious adverse effects and