CPAP is the treatment of choice for moderate-to-severe obstructive sleep apnea (OSA). But researchers from the University of Missouri School of Medicine have found this treatment may not be as effective in patients older than 80.
In this study, published in Sleep Medicine, researchers studied 369 participants over the age of 70 with OSA and assigned roughly half to receive CPAP therapy for three months. Researchers used several metrics to compare both groups, including a subjective measure of a patient’s sleepiness, the effect of CPAP on sleep-related quality of life, the effect on anxiety and depression, and impact on blood pressure levels. They further subdivided the results by those older and younger than 80.
“Our findings suggest that CPAP treatment is not as effective in patients over 80 years of age with OSA when compared to younger patients,” says senior author David Gozal, MD (pictured), the Marie M. and Harry L. Smith Endowed Chair of Child Health at the MU School of Medicine, in a release. “We did not see any improvements in OSA-related symptoms, quality-of-life metrics, mood-related symptoms, or blood pressure compared to the group that did not receive CPAP treatment.”
Gozal says patients over 80 typically have a more sedentary lifestyle, and the presence of other disorders that may also affect the quality or quantity of sleep, but cannot be addressable with CPAP. He also cited other previous studies that suggest that patients older than 80 are less likely to adhere to CPAP therapy long-term.
“Considering the growing population of elderly patients that is being referred for sleep consultation, large clinical trials are urgently needed to try to solve key questions related to the use of CPAP in patients over the age of 75 or 80,” Gozal says. “Those questions include: What type of elderly patient with OSA will benefit from CPAP? Is CPAP a cost-effective treatment for patients in this age group? And once CPAP treatment is initiated, should it last forever?”
In addition to Gozal, the study authors include several researchers from Spain, including co-lead author M.A. Martinez-Garcia, MD, PhD, section head of pneumology from Hospital Universitario and Politenico La Fe in Valencia.
Photo credit Justin Kelley, MU Health Care
Wow! Here I am at age 79, more fit and active than I have been in over 20 years in large part due to CPAP for severe sleep apnea begun (and steadfastly compliant) at age 73. Too bad that it appears from this study that I will be judged non-compliant at age 80 and need to stop CPAP therapy at that time…
I am a 78 year old retired RN and have been on CPAP for 24 years. I feel great with no cardiac issues. No one better come after my CPAP when I turn 80….I am 100% compliant.
After reading this article, it sounds like the CPAP group was not fully compliant with their therapy (average compliance 4.3 hours). They probably sleep a lot more than that. There is definitely more impromptu napping with older populations and my guess is that PAP was probably not used during these times.
The comments above make the case for earlier diagnosis. PAP is a habit-changing therapy. And habits are easier to establish earlier in life than later. If someone has a habit of cat napping on the recliner, and only sleeping a few hours per night, or going back to bed without using their CPAP after a washroom trip is not fully compliant and will not experience the subjective benefits (ESS, mood, QOL) of therapy.