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Nighttime Oxygen Desaturation and Symptoms of Sleep-Disordered Breathing in Long-Stay Nursing Home Residents

¹ University of California, Los Angeles, Multicampus Program in Geriatric Medicine and Gerontology, and VA Greater Los Angeles Healthcare System, Geriatric Research Education and Clinical Center, Los Angeles, California.
² Jefferson Medical College, Philadelphia, Pennsylvania.

Address correspondence to Jennifer L. Martin, PhD, VA Medical Center, GRECC (11E), 16111 Plummer Street, North Hills, CA 91343. E-mail: jemartin{at}ucla.edu

Background. Sleep-disordered breathing (SDB) is common in older adults and has been implicated as a cause of decreased quality of life and even death. Sparse data exist on SDB in the nursing home setting. The authors evaluated SDB (using attended nocturnal pulse oximetry) in nursing home residents with daytime sleepiness and nighttime sleep disturbance.

Methods. Pulse oximetry was used to estimate the prevalence of nighttime oxygen desaturation in 109 long-stay nursing home residents (mean [standard deviation] age = 86.2 [9.2] years; 74% women). Pulse oximetry findings were compared to a structured observational measurement of symptoms of SDB, the Observational Sleep Assessment Instrument. Seventy-one participants had concurrent wrist actigraphy to estimate total sleep time during oximetry recording.

Results. Using the oxygen desaturation index (ODI; average number of oxygen desaturations 4% or more below the baseline level per hour), the authors found that 40% of the residents had abnormal ODI (ODI more than 5, which is suggestive of SDB). Of all observational variables assessed, only loud breathing during sleep was significantly correlated with ODI (r =.284; p =.003). When ODI was adjusted for estimated total sleep time, higher adjusted ODI was associated with higher body mass index (kg/m²).

Conclusions. Abnormal ODI is common in nursing home residents. Observed loud breathing at night and high body mass index may suggest that further assessment of SDB is indicated. Future research should determine the importance of SDB and abnormal nocturnal oxygen desaturation on functioning and quality of life in nursing home residents.