The role of CPAP treatment in elderly patients with moderate obstructive sleep apnea. A Multicenter Randomised Controlled Trial

Abstract

The efficacy of continuous positive airway pressure (CPAP) treatment in elderly patients with non-severe obstructive sleep apnea (OSA) is controversial.

The objective of this study was to assess the effect of CPAP treatment in elderly patients with moderate OSA on clinical, quality of life and neurocognitive spheres.

Open-label, randomised, multicenter clinical trial in 143 elderly (≥70 years old) patients with confirmed moderate OSA (apnea-hypopnea index between 15 and 29.9 events·h⁻¹) randomised to receive CPAP (n=73) or no CPAP (n=72) for 3 months. The primary endpoint was the Epworth Sleepiness Scale (ESS) value, and the secondary endpoints included quality of life (Quebec Sleep Questionnaire [QSQ]), sleep-related symptoms, presence of anxiety/depression, office-based blood pressure measurements and some neurocognitive tests. The analysis was performed according to the intention-to-treat principle.

Mean (sd) age was 74.9 (4.6) years. The CPAP group achieved a greater improvement in the EES value (adjusted difference of 2.6 [95%CI: 3.6–1.6], effect size: 1), in some sleep-related symptoms and in some dimensions of the QSQ questionnaire (nocturnal symptoms: 0.7 [95%CI: 0.3–1];p<0.0001, and emotions: 0.4 (0.1–0.7);p=0.023). However, CPAP did not demonstrate any effect on either the neurocognitive tests (including anxiety and depression) or the blood pressure levels. There was a positive correlation between the effect of CPAP and the improvement in EES values and quality of life domains.

CPAP treatment resulted in a significant improvement in diurnal hypersomnia and some sleep-related symptoms and quality of life domains in elderly patients with moderate OSA.

Clinical trial registered with www.clinicaltrials.gov (NCT03079466)