**Abstract**

The purpose of this study was to examine the relationship between snoring and obstructive sleep apnea/hypopnea index in community dwelling older men and women. In this retrospective case-series study, the author was using a sequential collection of clinical datum design. There were 124 community-dwelling elders (mean age=71.85 years, Standard Deviation=4.85 years) with complaints of sleep disturbance. Including 46 females (F: M= 1:1.71), all the total subjects with sleep disturbance, after meeting the following criteria of exclusion: age below 65 years, heart failure, and chronic obstructive lung disease, were admitted to the sleep medicine laboratory where sleep questionnaire was used. They underwent in laboratory over-night polysomnography (PSG). The period of this study was 13 months; the total number of subjects whom took PSG in this Sleep Center Laboratory was 1,087 individuals during this period. The proposed neural model used is a generalized regression neural network (GRNN). This neural model has some advantages such as cost and time efficiencies in relation to experimental measurements. The training speed of the proposed technique is faster and the network architecture is simpler. In all likelihood, this model can be used in clinical applications that can reduce the necessity of in-laboratory nocturnal sleep studies since it has surpassed current classification approaches in terms of accuracy, simplicity, cost, time efficiency, and generalization. The correlation between snoring and AH1 was evaluated, though there was no measurement of vasopressin-positive and vasoactive-intestinalpolypeptide (AVP) neurons in postmortem examination of suprachiasmatic nucleus (SCN), as there was no death case. To the contrary, focus was set on the analysis of sleep disturbances that could be interpreted as the result of altered SCN function. The relationship between Snoring and AHI for the elderly with regard to its clue and impact on INSOMNIA is presented. The relationship between clinical sleep apnea and the physiological events surrounding the octogenarians was assessed. Clinically no indication for any brain tissue biopsy.

**Keywords:** apnea/hypopnea index (AHI), insomnia, obstructive sleep apnea, polysomnography (PSG), snoring, suprachiasmatic nucleus (SCN) nucleus, vasoactive-intestinal-polypeptide (AVP) neurons

### **1. Introduction**

Sleep apnea is a condition that causes breathing to stop and start repeatedly during sleep. It can leave a person extremely exhausted and sleepy during the day; it is even

**Figure 1.** *Histogram of AHI distribution.*

dangerous to one's own health. On the other hand, obstructive sleep apnea is the most common type of sleep apnea and it happens when the potential patients' airway is blocked and causes pauses in breathing and subsequently loud snoring. Normal snoring usually does not interfere with the quality of sleep almost as much as sleep apnea does. The author's data set were checked for normality of AHI distributions using the Kolmogorov-Smirnov's and Shapiro-Wilk's tests. The results (**Figure 1**) suggest that the data significantly deviate from a normal distribution, therefore, The null hypothesis of a normal distribution is rejected in this data set [1].

## **2. Materials and methods**

#### **2.1 Data collection**

This study utilized the sequential collection of nocturnal EEG data from a community dwelling of older adults.

It was conducted from January 1, 2002 to January 31, 2003 at the Sleep Medicine Center (Laboratory) of Changhua Christian Hospital, Taiwan. Subjects with heart failure and chronic obstructive lung disease were excluded from the study, since there was no physician at night in the Sleep Medicine Laboratory.

The Hospital Internal Research Board and Ethical Committee approved the study, which was in conformity with the Declaration of Helsinki. The author reports no conflict of interest. Under these circumstances, among the consecutive subjects who underwent nocturnal polysomnography (PSG) during that period, there were alltogether 1,087 cases of PSG performed. The data belonged to individuals who were younger than 65 years were excluded. Hence, the inclusion criteria were (1) the chief complaint of sleep disturbance and (2) aged 65 years and over.

Therefore, 124 participants were selected out of 1,087 cases of PSG taken during study period. Not one of the participants was demented and they aged from 65 to 88.5 years. Also, no pairs of individuals were related to each other. Body mass index (BM1) data were available from 117 individuals and there were 11 octogenarians. The participants of this study provided consents that also include

*Impact of Insomnia in the Elderly: The Correlation between Snoring and Apnea/Hypopnea Index DOI: http://dx.doi.org/10.5772/intechopen.100167*

their personal and medical data. In addition, at the time of their initial evaluation and enrollment, they all authorized clinical data in the research database to be used in this study. All data used in accordance with the spirit and principles of Health Insurance Portability and Accountability Act regulations (H1PAA, 1996) [2]. All other data referred from other published studies with all their sources were respectively specified for the purpose of comparison. The Author reports no conflict of interest. Each individual gave a written informed consent. This author reports no conflict of interest.

#### **2.2 Apnea hypopnea index**

Initially, the subjects accomplished the Epworth Sleepiness Scale and Quality of Life SF-36 (QOL) sleep questionnaires to measure excessive daytime sleepiness (ESG). This tool is widely recognized and accepted because it is simple to use. The results of polysomnography (PSG) were collected from the participants and evaluated based on the apnea hypopnea index (AH1). There was a significant reduction in QOL for the apneic subjects. The degree of reduction was proportional to severity. For apneics with AH1 >30, there was greater impact on vitality, physical functioning, social functioning, mental health, and emotional functioning. Among the total 124 individuals, there was no single one who was demented. There was no pair of individuals related to each other.

#### **2.3 Obstructive sleep apnea**

The sleep recordings were scored according to the classification developed by Rechtschaffen and Kales [1, 3]. Kales et al used special techniques that allow subject mobility and obtain continuous electroencephalographic recordings of sleepwalkers [4]. An apneic event was defined as a reduction in airflow greater than ≥ 90% for a duration of 10 seconds or longer. A hypopneic event was scored if there is a decrease of airflow for at least 10 seconds in respirations, a 30-percent reduction in ventilation, and a decrease in oxygen saturation. The apnea hypopnea index (AH1) was calculated as the sum of events of apneas and hypopnea as per hours of nocturnal sleep. Subject with an AH1 of five or more was considered as having a diagnosable case of obstructive sleep apnea (OSA).

#### **2.4 Polysomnography**

Polysomnography (PSG) was conducted from 9:30 pm to 6:30 am in the sleep laboratory using Alice 4 Sleep Diagnostic System, Respironics, Carlsbad, Calif, USA and finger pulse oxymetry (model N 200. Nellcor, Hayward, California, U. S.). As far as the recordings are concerned, the latter included recording the central and occipital electroencephalogram (EEG) derivations (C3, C4, Ol, O2), bilateral electrooculogram (left outer canthus and right outer canthus), submental and anterior tibialis electromyogram (EMG), electrocardiogram, nasal/oral airflow were using a thermistor, respiratory effort using chest and abdominal inductance belts.

#### **2.5 Sleep-disordered breathing**

Sleep-disordered breathing (SDB) has been defined as having AH1 score of five or higher.
