Older Patients With OSA Have More Comorbidities at Similar Severity

Older patients with obstructive sleep apnea (OSA) carried a markedly higher burden of cardiometabolic disease and reported poorer sleep quality than younger patients, even though their respiratory severity was comparable, according to a cross-sectional study of 1508 patients in China published in Sleep and Breathing.¹

Investigators at Peking Union Medical College Hospital retrospectively reviewed adults aged 18 to 88 years who underwent in-laboratory polysomnography between 2022 and 2025. Of 1840 participants, 1508 (82.0%) had OSA, defined as an apnea-hypopnea index (AHI) of 5 or more events per hour. All participants were treatment-naive. The team continuously compared 5 age groups and modeled age to test for nonlinear associations.

Comorbidities Were More Common at Older Ages

Cardiovascular disease prevalence was 3.3% in the youngest group (18 to 39 years) and 56.2% in the oldest (70 years and older). Hypertension prevalence was 21.6% and 57.8%, diabetes 6.9% and 21.9%, and statin use 8.7% and 65.6% (all P < .001).

In sex-adjusted models, comparing age 60 with age 40, odds ratios for prevalent disease were 2.79 (95% CI, 2.29-3.41) for hypertension, 8.18 (95% CI, 5.74-11.66) for cardiovascular disease, and 2.43 (95% CI, 1.87-3.16) for diabetes. The associations persisted after additional adjustment for body mass index (BMI), smoking, and alcohol use.

An American Heart Association scientific statement similarly reported OSA prevalence as high as 40% to 80% among patients with conditions such as hypertension, coronary artery disease, and stroke and described the disorder as often underrecognized in cardiovascular practice.²

Respiratory Severity Was Broadly Comparable Across Ages

Polysomnography measures were broadly similar across age groups, with no significant differences in AHI, oxygen desaturation index, percentage of sleep time below 90% saturation, or lowest oxygen saturation (all P > .10).¹ Moderate-to-severe OSA, defined as an AHI of 15 or more events per hour, occurred in 71.8% to 78.1% of patients across groups (P = .685).

BMI was highest in the youngest group, as was obesity prevalence (50.9% vs 31.2% in the oldest). The authors wrote that lower BMI with comparable AHI in older patients is compatible with greater airway vulnerability, though direct measurement of collapsibility would be needed to test that.

Median global Pittsburgh Sleep Quality Index scores (higher scores indicate poorer sleep) were 7 in the youngest group and 9 in the oldest (P < .001). In contrast, excessive daytime sleepiness, defined as an Epworth Sleepiness Scale score of 11 or higher, peaked at 56.2% among patients aged 50 to 59 years and fell to 35.9% in those 70 years and older (P = .030), a nonlinear pattern (P for nonlinearity < .001).

The authors said these patterns support assessing nocturnal symptoms, daytime function, and comorbidities together in older patients, alongside respiratory indices.

OSA Detection Was Higher at Older Ages, Especially in Women

Among all participants undergoing polysomnography, the age-related increase in the share of patients found to have OSA was greater in women (48.2% in the youngest group, 77.1% in the oldest) than in men (83.2% and 92.5%), who had higher rates at every age (age-by-sex interaction P = .031). The authors suggested menopause-related changes may contribute, but menopausal status and hormone exposure were not measured, so the findings do not establish an estrogen-mediated effect.

The oldest age group included only 64 patients, and the study was single-center and cross-sectional. It lacked an age-matched control group without OSA, so it cannot show whether the differences are specific to OSA. Data on disease onset were unavailable, and sleep quality and sleepiness were self-reported.

“OSA clinical profiles differ across ages, with nonlinearity in selected measures,” the authors wrote. “Older patients had greater cardiometabolic burden and poorer reported sleep quality despite comparable respiratory severity, while EDS showed a midlife elevation. These findings support considering age with symptoms, body habitus, and comorbidities and generate hypotheses for age-informed stratification and individualized care. Clinical thresholds and treatment benefits require prospective evidence.”

References

1. Li J, Huang R, Luo J, Xiao Y. Nonlinear age-related differences in clinical profiles of obstructive sleep apnea: a cross-sectional study of 1,508 Chinese patients. Sleep Breath. 2026;30:288. doi:10.1007/s11325-026-03836-3

2. Yeghiazarians Y, Jneid H, Tietjens JR, et al. Obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;144(3):e56-e67. doi:10.1161/CIR.0000000000000988