Jennifer Pallansch1, Yiping Li2, James Bena3, Lu Wang3, Nancy Foldvary-Schaefer4. 1. Case Western Reserve University School of Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. 2. Kaiser Permanente Los Angeles Medical Center (LAMC), Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. 3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. 4. Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
STUDY OBJECTIVES: Although continuous positive airway pressure (CPAP) therapy is regarded as the gold standard treatment for obstructive sleep apnea (OSA) in adults, outcomes in older patients are limited. This study examines the effect of CPAP therapy in older adults with OSA (older than 60 years) compared to younger adults (age 18 to 60 years) to inform the current standard of practice. METHODS: We performed a retrospective study with a convenience sample to compare responses to CPAP treatment in older versus younger adults with OSA using validated, patient-reported outcomes (PROs). A total of 532 patients were analyzed at baseline and at 3, 6, and 12 months after CPAP initiation. The effects of CPAP adherence and OSA severity on PRO scores were measured in each age group. RESULTS: Patients older than 60 years had higher apnea-hypopnea indices but lower Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient Health Questionnaire-9 (PHQ-9) scores and higher Functional Outcomes of Sleep Questionnaire (FOSQ) scores at baseline compared to patients age 18 to 60 years. At 1 year after CPAP initiation, significant and comparable improvements in ESS, FSS, PHQ-9, and FOSQ scores were observed in patients older than 60 years relative to younger patients. When stratifying by OSA severity, change between age groups was significantly different only for PHQ-9 in patients with mild OSA, with greater improvements observed in younger patients. CONCLUSIONS: This study adds to the limited data on treatment outcomes with CPAP therapy in older adults with OSA. Patients older than 60 years achieve improvement in sleepiness, fatigue, depressive symptoms, and quality of life analogous to that of younger adults.
STUDY OBJECTIVES: Although continuous positive airway pressure (CPAP) therapy is regarded as the gold standard treatment for obstructive sleep apnea (OSA) in adults, outcomes in older patients are limited. This study examines the effect of CPAP therapy in older adults with OSA (older than 60 years) compared to younger adults (age 18 to 60 years) to inform the current standard of practice. METHODS: We performed a retrospective study with a convenience sample to compare responses to CPAP treatment in older versus younger adults with OSA using validated, patient-reported outcomes (PROs). A total of 532 patients were analyzed at baseline and at 3, 6, and 12 months after CPAP initiation. The effects of CPAP adherence and OSA severity on PRO scores were measured in each age group. RESULTS:Patients older than 60 years had higher apnea-hypopnea indices but lower Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Patient Health Questionnaire-9 (PHQ-9) scores and higher Functional Outcomes of Sleep Questionnaire (FOSQ) scores at baseline compared to patients age 18 to 60 years. At 1 year after CPAP initiation, significant and comparable improvements in ESS, FSS, PHQ-9, and FOSQ scores were observed in patients older than 60 years relative to younger patients. When stratifying by OSA severity, change between age groups was significantly different only for PHQ-9 in patients with mild OSA, with greater improvements observed in younger patients. CONCLUSIONS: This study adds to the limited data on treatment outcomes with CPAP therapy in older adults with OSA. Patients older than 60 years achieve improvement in sleepiness, fatigue, depressive symptoms, and quality of life analogous to that of younger adults.
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