Most patients referred for evaluation of sleep apnea, a condition in which airways become blocked during sleep and breathing stops for brief periods, are in their 50s, but men in their 20s with this condition appear to have the highest risk of death, an Israeli research team reports.

“The implication is that we must diagnose patients while they’re young, in their 20s and 30s, if we are to prevent mortality,” Dr. Peretz Lavie told Reuters Health.

Lavie and colleagues at Technion-Israel Institut of Technology in Haifa examined the survival rates of nearly 14,000 men between 20 and 93 years old evaluated over a 10-year period at their clinic for possible sleep apnea.

During an average follow-up of 4.6 years, there were 372 deaths.

Among those with a respiratory disturbance index (RDI) score greater than 30, only men between 20 and 29 years old had a significantly higher mortality than their counterparts in the general population, the investigators report in the European Respiratory Journal.

The researchers performed another analysis that was restricted to the 1,909 patients with severe sleep apnea (RDI scores greater than 50 and an average of 73 respiratory events per hour of sleep), among whom 95 died during follow-up.

In this group, the mortality rate for men in their 20s was nearly 10 times greater than that seen in the general population. For men 30-to-39 years old and those 40-to-49 years old, mortality rates were more than three times and almost two times higher, respectively. Men who were 50 year of age or older did not have a higher mortality risk.

Given these surprising results, Lavie said, “We believe…some individuals are able to develop a coping mechanism that allows to them to live with this nightly insult of [oxygen deprivation] and brief awakenings.”

He noted that there are three high-risk groups that should probably undergo screening. Young obese patients with a body mass index of 31 or higher is the first target population, “because the combination of severe apnea and obesity at this age is a killer.” Other targets are patients who have a parent with sleep apnea, and those who develop high blood pressure at a young age.

To bring down the cost of screening, Lavie and his associates have developed a device, called the WatchPAT, comprised of sensors that are placed on the fingers at night. A positive result using this device, which has been approved by the US FDA, means that a complete workup for obstructive sleep apnea is needed.

SOURCE: European Respiratory Journal, March 2005.