02787nas a2200337 4500008004100000022001400041245010800055210006900163260001300232300001100245490000800256520186600264653001602130653000902146653002202155653001102177653001102188653001102199653000902210653003002219653002002249653001702269653001502286653001902301100001802320700002102338700001702359700001902376700001902395856003502414 1999 eng d a0012-369200aUnderdiagnosis and undertreatment of asthma in the elderly. Cardiovascular Health Study Research Group.0 aUnderdiagnosis and undertreatment of asthma in the elderly Cardi c1999 Sep a603-130 v1163 a

OBJECTIVE: To describe the clinical correlates of asthma in a community-based sample of elderly persons.

PARTICIPANTS: A community sample of 4,581 persons > or = 65 years old from the Cardiovascular Health Study.

MEASUREMENTS: Standardized respiratory, sleep, and quality-of-life (QOL) questions, a medication inventory, spirometry, and ambulatory peak flow.

RESULTS: Four percent of the participants reported a current diagnosis of asthma (definite asthma), while another 4% reported at least one attack of wheezing accompanied by chest tightness or dyspnea during the previous 12 months (probable asthma). Smokers and those with congestive heart failure were excluded from the subsequent analyses, leaving 2,527 participants. Of those who had definite asthma, 40% were taking a sympathomimetic bronchodilator, 30% inhaled corticosteroids, 21% theophylline, and 18% oral corticosteroids; 39% were taking no asthma medications. The participants with definite or probable asthma were much more likely than the others to have a family history of asthma, childhood respiratory problems, a history of workplace exposures, dyspnea on exertion, hay fever, chronic bronchitis, nocturnal symptoms, and daytime sleepiness. They were also more likely to report poor general health, symptoms of depression, and limitation of activities of daily living. There was little difference in the morbidity and QOL of participants with recent asthma-like symptoms who had received the diagnosis of asthma versus those who had not.

CONCLUSIONS: Asthma in elderly persons is associated with a lower QOL and considerable morbidity when compared with those who do not have asthma symptoms. Asthma is underdiagnosed in this group and is often associated with allergic triggers; inhaled corticosteroids are underutilized.

10aAge Factors10aAged10aAged, 80 and over10aAsthma10aFemale10aHumans10aMale10aPeak Expiratory Flow Rate10aQuality of Life10aRisk Factors10aSpirometry10aVital Capacity1 aEnright, P, L1 aMcClelland, R, L1 aNewman, A, B1 aGottlieb, D, J1 aLebowitz, M, D uhttps://chs-nhlbi.org/node/60103847nas a2200421 4500008004100000022001400041245013700055210006900192260001600261300001200277490000800289520270400297653001003001653000903011653001903020653002803039653001103067653001103078653001703089653002003106653000903126653001603135653001203151653002003163653002603183653001203209100001603221700001603237700001503253700001403268700001603282700001503298700002103313700001703334700001903351700002003370856003503390 2000 eng d a0098-748400aAssociation of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study.0 aAssociation of sleepdisordered breathing sleep apnea and hyperte c2000 Apr 12 a1829-360 v2833 a

CONTEXT: Sleep-disordered breathing (SDB) and sleep apnea have been linked to hypertension in previous studies, but most of these studies used surrogate information to define SDB (eg, snoring) and were based on small clinic populations, or both.

OBJECTIVE: To assess the association between SDB and hypertension in a large cohort of middle-aged and older persons.

DESIGN AND SETTING: Cross-sectional analyses of participants in the Sleep Heart Health Study, a community-based multicenter study conducted between November 1995 and January 1998.

PARTICIPANTS: A total of 6132 subjects recruited from ongoing population-based studies (aged > or = 40 years; 52.8% female).

MAIN OUTCOME MEASURES: Apnea-hypopnea index (AHI, the average number of apneas plus hypopneas per hour of sleep, with apnea defined as a cessation of airflow and hypopnea defined as a > or = 30% reduction in airflow or thoracoabdominal excursion both of which are accompanied by a > or = 4% drop in oxyhemoglobin saturation) [corrected], obtained by unattended home polysomnography. Other measures include arousal index; percentage of sleep time below 90% oxygen saturation; history of snoring; and presence of hypertension, defined as resting blood pressure of at least 140/90 mm Hg or use of antihypertensive medication.

RESULTS: Mean systolic and diastolic blood pressure and prevalence of hypertension increased significantly with increasing SDB measures, although some of this association was explained by body mass index (BMI). After adjusting for demographics and anthropometric variables (including BMI, neck circumference, and waist-to-hip ratio), as well as for alcohol intake and smoking, the odds ratio for hypertension, comparing the highest category of AHI (> or = 30 per hour) with the lowest category (< 1.5 per hour), was 1.37 (95% confidence interval [CI], 1.03-1.83; P for trend = .005). The corresponding estimate comparing the highest and lowest categories of percentage of sleep time below 90% oxygen saturation (> or = 12% vs < 0.05%) was 1.46 (95% CI, 1.12-1.88; P for trend <.001). In stratified analyses, associations of hypertension with either measure of SDB were seen in both sexes, older and younger ages, all ethnic groups, and among normal-weight and overweight individuals. Weaker and nonsignificant associations were observed for the arousal index or self-reported history of habitual snoring.

CONCLUSION: Our findings from the largest cross-sectional study to date indicate that SDB is associated with systemic hypertension in middle-aged and older individuals of different sexes and ethnic backgrounds.

10aAdult10aAged10aCohort Studies10aCross-Sectional Studies10aFemale10aHumans10aHypertension10aLogistic Models10aMale10aMiddle Aged10aObesity10aPolysomnography10aSleep Apnea Syndromes10aSnoring1 aNieto, F, J1 aYoung, T, B1 aLind, B, K1 aShahar, E1 aSamet, J, M1 aRedline, S1 aD'Agostino, R, B1 aNewman, A, B1 aLebowitz, M, D1 aPickering, T, G uhttps://chs-nhlbi.org/node/61302660nas a2200397 4500008004100000022001400041245006800055210006700123260001300190300001100203490000800214520152600222653000901748653002201757653001001779653001101789653001101800653001801811653001101829653000901840653002701849653003001876653003001906653004301936653002101979653003302000653001702033653004102050653001502091100001802106700002102124700001602145700001902161710004702180856003502227 2001 eng d a0012-369200aCorrelates of peak expiratory flow lability in elderly persons.0 aCorrelates of peak expiratory flow lability in elderly persons c2001 Dec a1861-80 v1203 a

OBJECTIVE: To determine the correlates of the lability of peak expiratory flow (PEF) in the elderly.

METHODS: A community sample of 4,581 persons > or = 65 years old from the Cardiovascular Health Study completed an asthma questionnaire and underwent spirometry. During a follow-up examination of the cohort, 1,836 persons agreed to measure PEF at home twice daily for 2 weeks, and 90% successfully obtained at least 4 days of valid measurements. PEF lability was calculated as the highest daily (PEF maximum - PEF minimum)/mean PEF.

RESULTS: Mean PEF measured at home was accurate when compared to PEF determined by spirometry in the clinic. Mean PEF lability was 18% in those with current asthma (n = 165) vs 12% in healthy nonsmokers (upper limit of normal, 29%). Approximately 26% of those with asthma and 14% of the other participants had abnormally high PEF lability (> 29%). After excluding participants with asthma, other independent predictors of high PEF lability included black race, current and former smoking, airway obstruction on spirometry, daytime sleepiness, recent wheezing, chronic cough, emphysema, and wheezing from lying in a supine position. Despite having a lower mean PEF, those reporting congestive heart failure (n = 82) did not have significantly higher PEF lability.

CONCLUSIONS: Measurement of PEF lability at home is highly successful in elderly persons. PEF lability > or = 30% is abnormal in the elderly and is associated with asthma.

10aAged10aAged, 80 and over10aAging10aAsthma10aFemale10aHeart Failure10aHumans10aMale10aMonitoring, Ambulatory10aPeak Expiratory Flow Rate10aPredictive Value of Tests10aPulmonary Disease, Chronic Obstructive10aReference Values10aRhinitis, Allergic, Seasonal10aRisk Factors10aSignal Processing, Computer-Assisted10aSpirometry1 aEnright, P, L1 aMcClelland, R, L1 aBuist, A, S1 aLebowitz, M, D1 aCardiovascular Health Study Research Group uhttps://chs-nhlbi.org/node/671