Recommendations for special challenges faced by technical personnel with geriatric patients in the sleep laboratory - a consensus statement.

backgroundSleep disorders increase with increasing age. In the USA, 50% of the population 65 yrs and older complain about sleep problems. Therefore, older patients make up a large portion of clients in the sleep laboratory with polysomnography for diagnosis and therapy.

methodsThe technical staff faced with older clients in the sleep laboratory experience several special challenges with this cohort, which are discussed and given recommendations to deal with them in this statement by consensus RESULTS AND RECOMMENDATIONS: Technicians must be aware of different normal values of sleep stage distribution, arousals, sleep efficiency and mean oxygen saturation. The changes in electrophysiologic signals with lower amplitudes in the electroencephalogram of older people increase the difficulties to distinguish between sleep stages. Older adults present with dryer skin which leads to higher electric resistance, weakening electrophysiologic signal quality. The automatic analysis of polysomnography devices can most often not be applied and electrophysiologic channels must be analyzed manually. Older sleep laboratory clients often need more care during the night and home polysomnographies are difficult to perform. Nycturia, the risk of falls and reduced cognitive function with disorientation during the night in elderly increase these difficulties. Special challenges can come from dentures worn or taken out at night, a more often tendency to keep the mouth open during breathing, being frightened to wear a nasal or full-face mask, not understanding the procedure and the need for therapy overall and the forced influence and interventions of relatives before, during and after polysomnography. The collaboration with relatives on the other hand is often needed to perform the diagnostic and therapeutic procedures.