INTRODUCTION In New Zealand (NZ), access to public sleep services is limited to people deemed with the highest need. The prevalence of obstructive sleep apnoea (OSA) increases with age, but the symptoms and the treatment pathway is expected to differ for older compared to younger patients. This study explored the experience of older people regarding diagnosis and treatment services for OSA in order to inform considerations required in primary health and sleep services. METHODS Patients who were initiated on Continuous Positive Airway Pressure (CPAP) therapy at the age of 65 years or older were invited to one of three 1.5-h focus group discussions. In total, 16 patients attended; nine were accompanied by their spouse or partner. Discussions were semi-structured and explored experiences with the OSA pathway, from diagnosis through to long-term management. RESULTS Thematic analysis highlights the key symptoms of OSA. Patients' experiences with diagnostic and treatment services were generally positive. However, there was an overarching need for greater knowledge and follow up regarding OSA and CPAP therapy. Most patients were happy with CPAP treatment. Issues associated with long-term use, comfort and daily management were highlighted, and strategies used to overcome them discussed. DISCUSSION Focus groups reported similar experiences, positively endorsing the health value of OSA diagnosis and CPAP therapy. Mechanisms and resources are required at a primary healthcare level in order to raise awareness around sleep and aging, OSA and CPAP. This would aid earlier and more appropriate diagnosis and management of OSA and help overcome some of the gaps identified in this study.
within cognitive domains. Subgroup analyses were performed taking into account risk of bias and moderating differences in study design. Results: 13 studies met eligibility criteria for analysis. A small negative association was found between OSA and all neuropsychological outcomes combined, g=0.16 (95% CI 0.02-0.29), and in memory and processing speed domains. Small case-control studies from sleep clinic populations observed the greatest associations, while larger cohort studies from community samples illustrated no association. Analysis accounting for publication bias resulted in a null overall association, g=0.01 (95%CI -0.14 to 0.16). Conclusion:Associations between OSA and cognition in later life are highly variable and the findings differ based on study type and setting. It appears some older adults may be at risk of cognitive impairments attributable to OSA; however, the risk of bias renders the current evidence inconclusive. Further comprehensive research is warranted in older clinically diagnosed OSA patients as well as those already experiencing neuropsychological impairment and who may be regarded at higher risk of further cognitive decline. Support (If Any): N/A. CONTINUOUS POSITIVE AIRWAY PRESSURE IMPROVES ARTERIAL STIFFNESS AND ENDOTHELIAL PROGENITOR CELLS (CD34+ CELLS) Introduction:Obstructive Sleep Apnea (OSA) is an independent risk factor for cardiovascular diseases, mediated in part by endothelial dysfunction. It has been reported that OSA patients have increased endothelial oxidative stress, inflammation, and reduced endothelial repair capacity. Continuous Positive Airway Pressure (CPAP) is the mainstay of OSA treatment, and has been shown to decrease cardiovascular disease (CVD) risk. Circulating endothelial progenitor cells (EPCs) are intrinsic to vascular repair and regeneration, and help to maintain endothelial integrity. Arterial stiffness (AS) is an established predictor of endothelial health and CVD risk. Here, we studied the effect of CPAP treatment on EPCs and AS in OSA patients. Methods: 8 patients with moderate to severe OSA were enrolled. Pulse Wave Velocity (PWV), a measure of AS, and EPCs (CD34+) were assessed at baseline, and after 3 months of treatment with CPAP. The Wilcoxon Signed Rank Test was used to test changes in measurements per day of CPAP > 4hr (median of 48 days). Results: Arterial stiffness, measured by PWV, was improved with CPAP treatment (p = 0.008). Although no statistically significant change was noted in EPC colony forming units, the percent of CD34+ cells (relative to total mononuclear cells) increased after treatment (p = 0.05). Additionally, in targeted gene expression analysis, a trend towards increased gene expression was noted for eNOS (endothelial nitric oxide synthase) and CXCR4 (a receptor for SDF1A, a known chemotactic factor for EPCs). Conclusion: An improvement in arterial stiffness, along with an increase in CD34+ cell numbers most likely explains the cardiovascular risk reduction post CPAP therapy. While a larger cohort is needed to elucidate the...
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