Continuous positive airway pressure treatment for sleep apnea in older adults

Abstract

Daytime sleepiness and sleep disordered breathing are increased in older compared to middle-aged adults. The cognitive and cardiovascular sequelae associated with obstructive sleep apnea (OSA) have significant implications for the older adult who may already be suffering from chronic illness. Most of the evidence supporting the utilization of continuous positive airway pressure (CPAP) for the treatment of OSA has been generated from studies employing samples consisting predominately of middle-aged adults. To examine the efficacy of CPAP for the treatment of obstructive sleep apnea in older adults with an emphasis on adherence and related treatment outcomes, this paper reviews findings from clinical trials including older individuals as well as those specifically targeting this population. These studies have demonstrated that following CPAP therapy, older adults have increased alertness, improved neurobehavioral outcomes in cognitive processing, memory, and executive function, decreased sleep disruption from nocturia and a positive effect on factors affecting cardiac function, including vascular resistance, platelet coagulability and other aspects of cardiovascular health. Physiological differences in respiratory structure and function between younger and older adults of similar disease severity are believed to result in older individuals requiring titration at lower CPAP levels. Once initiated, CPAP treatment is tolerated by older adults, including those with Alzheimer's disease. Patterns of adherence in older individuals are consistent with that of middle-aged adults.

Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment

“…In the present study around 70% of the patients tolerated CPAP for at least 4 h per night on average, which, despite some controversy in the literature in this respect, is similar to the percentages found in studies that include elderly patients [33,34]. In this sense, the present study showed a positive correlation between the hours of CPAP use and the improvement in some QSQ domains related to diurnal symptoms, nocturnal symptoms and the emotional sphere.…”

Management of Obstructive Sleep Apnea in Commercial Motor Vehicle Operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force

“…72 Therefore, the STSATF recommended that acceptable criteria for evaluating efficacy of prescribed OSA treatments address these three elements. Specific measures in each domain include a combination of physician judgement, symptom surveys (which may be useful if positive), objective testing, and adherence data.…”

Factors Affecting CPAP Acceptance in Elderly Patients With Obstructive Sleep Apnea in Taiwan

“…9 Elderly patients who use CPAP for OSA have increased alertness; improved neurobehavioral outcomes in cognitive processing, memory, and executive function; and decreased sleep disruption. 10 However, many elderly patients have difficulty accepting and tolerating CPAP, and frequently cease CPAP use. 11,12 CPAP cessation is also a problem in younger patients with OSA; indeed, there does not appear to be any marked difference in the rate of CPAP adherence in different age groups.…”