Use of continuous positive airway pressure (CPAP) improved obstructive sleep apnea (OSA) without any changes in the neurocognitive sphere or blood pressure readings in elderly patients with moderate to severe OSA, according to a study published in the European Respiratory Journal.
In this open-label, multicenter, randomized clinical trial of parallel groups with blinded end point design (ClinicalTrials.gov Identifier: NCT03079466), researchers analyzed data from sleep studies of patients aged ≥70 years suspected to have or diagnosed with OSA (N=143). Patients were initially recruited to the CPAP group (n=73) or the no CPAP group (n=72).
After the sleep study, patients completed a specific sleep-related quality of life questionnaire and a standardized protocol that included general and data; personal history related to cardiovascular, depression, anxiety or other neurocognitive diseases; current medication; and clinical history related to OSA, including chronic snoring, witnessed apneas, daytime hypersomnolence, nightmares, choking, and nocturia. After 12 weeks, all patients completed a second standardized protocol. CPAP adherence was objectively measured by reading the device’s time counter from the beginning of treatment to the end of follow-up.
Compared with the group who did not use a CPAP, the CPAP group achieved a greater improvement in Epworth Sleepiness Scale (ESS) values (adjusted difference, 2.6; 95% CI, -3.6 to -1.6; effect size, 1). The average use of CPAP treatment per night was 5.2 (standard deviation [SD], 2.5) hours. The mean apnea-hypopnea index (AHI) was 21.7 (SD, 4.8) events/h-1, with 93% of events obstructive.
Following the application of CPAP during the titration study, the residual AHI was 4 (SD, 3.2) events/h-1. The EES values were 9.4 (SD, 4.1) for the CPAP group and 8.9 (SD, 3.7) for the control group at baseline, and 5.9 (SD, 3.5) and 8.3 (SD, 3.8) at the end of the follow-up, respectively.
Study limitations included the fact that 75% of the sleep tests were conducted with home polygraphy in addition to the absence of a placebo group receiving sham-CPAP. Only 20 of the 144 patients were aged ≥80 years, limiting the researchers’ ability to infer study results in very elderly people.
The researchers indicated that in elderly patients suspected to have OSA, treatment with CPAP can significantly reduce hypersomnia and other sleep-related symptoms, and improve some health-related quality of life measures. It did not have an effect on neurocognitive variables, blood pressure readings, or degree of anxiety or depression.
Ponce S, Pastor E, Orosa B, et al. The role of CPAP treatment in elderly patients with moderate obstructive sleep apnea. A multicenter randomised controlled trial [published online June 4, 2019]. Eur Respir J. doi:10.1183/13993003.00518-2019