Clinical ReviewContinuous positive airway pressure treatment for sleep apnea in older adults
Introduction
Obstructive sleep apnea (OSA) is as common as diabetes mellitus and typically associated with middle-age. However, while an estimated 20% of middle-aged men have OSA,1 the prevalence of this sleep-related breathing disorder in older adults is greater, ranging from 24% to 42%.1, 2 Older adults have almost a three-fold increased risk of having sleep apnea.1 OSA is associated with significant neurocognitive3 and cardiovascular sequelae, 3problems commonly experienced by the general elderly population. Daytime sleepiness, the primary manifestation of OSA, occurs in approximately 9% of adults4 and results in decreased daily functioning in older adults.5 Indeed, daytime sleepiness occurs twice as often in individuals older than 75 years compared to middle-aged adults.4
Given the prevalence and functional impact of OSA in the elderly, treatment for sleep apnea holds considerable promise. In addition to conservative management, approaches to the treatment of OSA include nasal continuous positive airway pressure (CPAP), oral appliances and surgery. Continuous positive airway therapy is more commonly used as adequate dentition is required for oral appliances and the risk of surgery is increased in those over 50 years of age. The purpose of this review is to examine efficacy of CPAP treatment in the older adult with an emphasis on adherence and related treatment outcomes.
Section snippets
Prescription of CPAP treatment
Essential to the treatment of OSA is the accurate determination of the apnea-hypopnea index (AHI), the number of apneas and hypopneas that occur per hour of sleep. Night-to-night variability in disturbed breathing has previously been described.6 Findings from the Sleep Heart Health Study7 suggest that at lower levels of respiratory disturbances, night-to-night variability is a function of increasing respiratory events and age. In exploring night-to-night variability in disturbed breathing in
Efficacy of CPAP treatment
A recent review of the literature evaluating the efficacy of CPAP treatment demonstrated the positive impact of CPAP on the AHI, sleep architecture, daytime sleepiness, quality of life, neurobehavioral performance and psychological effects, and cardiovascular morbidity (see Table 1).18 The majority of the clinical trials reviewed for the practice parameters were conducted primarily in the middle-aged population.18
Given the number of clinical trials now available for review, with the exception
Conclusion
Documented by this review, there is a paucity of data regarding CPAP treatment in older sleep apnea patients. There have been few investigations of CPAP patterns of use in this population as well as whether outcomes achieved with younger individuals are also true in older patients who may be less sleepy, have a higher apnea and hypopnea index, and suffer from more co-morbidities. Whether reductions in daytime sleepiness demonstrated for older CPAP-treated patients will result in increased
References (55)
- et al.
Relative accuracy of algorithm-based prescription of nasal CPAP in OSA
Respir Med
(2004) - et al.
Factors associated with nightly variability in sleep-disordered breathing in the elderly
Chest
(1991) - et al.
Predicting effective continuous positive airway pressure
Chest
(2000) - et al.
Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome
Lancet
(1994) - et al.
Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial
The Lancet
(1999) - et al.
Continuous positive airway pressure normalizes cardiac autonomic and hemodynamic responses to a laboratory stressor in apneic patients
Chest
(2001) - et al.
Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial
Lancet
(2002) - et al.
A randomized, controlled trial of 1 week of continuous positive airway pressure treatment on quality of life
Heart Lung
(2003) - et al.
Effect of continuous positive airway pressure and placebo treatment on sympathetic nervous activity in patients with obstructive sleep apnea
Chest
(2001) - et al.
A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study
Sleep Med
(2004)
Neuropsychological changes and treatment compliance in older adults with sleep apnea
J Psychosom Res
The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox's proportional hazard analysis
Sleep Med
A prospective study of nocturia and the quality of life of elderly patients with obstructive sleep apnea or sleep onset insomnia
J Psychosom Res
Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS)
Sleep Med Rev
Adherence to continuous positive airway pressure treatment in patients with Alzheimer's disease and obstructive sleep apnea
Am J Geriatr Psychiatry
Effects of age on sleep apnea in men: I. Prevalence and severity
Am J Respir Crit Care Med
Are breathing disturbances in elderly equivalent to sleep apnea syndrome?
Sleep
Epidemiology of obstructive sleep apnea: a population health perspective
Am J Respir Crit Care Med
Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression
J Clin Endocrinol Metab
Functional outcomes of excessive daytime sleepiness in older adults
J Am Geriatr Soc
Short-term variability of respiration and sleep during unattended nonlaboratory polysomnography—the Sleep Heart Health Study
Sleep
Nightly variation in sleep-related respiratory disturbance in older adults
Exp Aging Res
Night-to-night variability in sleep apnea and sleep-related periodic leg movements in the elderly
Sleep
Night-to-night variability of disturbed breathing during sleep in an elderly community sample
Sleep
Comparing night-to-night variability of sleep measures in elderly African Americans and Whites
Behav Sleep Med
The determinants of therapeutic levels of continuous positive airway pressure in elderly sleep apnea patients
Respir Med
Physiological changes in respiratory function associated with ageing
Eur Respir J
Cited by (137)
Sleep in older adults
2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second EditionObstructive Sleep Apnea: Treatment with Positive Airway Pressure
2021, Clinics in Geriatric MedicineEfficacy of CPAP for Improvements in Sleepiness, Cognition, Mood, and Quality of Life in Elderly Patients With OSA: Systematic Review and Meta-analysis of Randomized Controlled Trials
2020, ChestCitation Excerpt :For instance, according to a study that evaluated sleep and osteoporotic fractures in men, hypoxia during sleep may be a risk factor for falls and bone fractures, and treatment with CPAP may be useful in the prevention of both complications.36 CPAP was effective at reducing the number of apnea and hypopnea events compared with the placebo and decreased stage 1 and increased stages 3 and 4 of sleep; these changes positively affected the sleep architecture and improved sleepiness in the elderly population.37 In our results, we found a pooled change of 2.62 points in the ESS.
Sleep disorders and aging
2020, Handbook of Mental Health and Aging
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The most important references are denoted by an asterisk.