Effect of continuous positive airway pressure in very elderly with moderate-to-severe obstructive sleep apnea pooled results from two multicenter randomized controlled trials

Martínez-García, Miguel Ángel; Oscullo, Grace; Ponce, Silvia; Pastor, Esther; Orosa, Belén; Catalán, Pablo; Martínez, Alfonso; Hernández, Luís; Muriel, Alfonso; Chiner, Eusebi; Vigil, Laura; Carmona, Carmen; Mayos, Mercedes; García-Ortega, Alberto; Gómez-Olivas, José Daniel; Beauperthuy, Thais; Bekki, Amina; Gozal, David

doi:10.1016/j.sleep.2021.11.009

Cited by 9 publications

(2 citation statements)

References 17 publications

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“…However, these results are conflicting with a 3-month RCT of CPAP therapy among elderly adults >70 years with moderate-severe OSA, which did not find significant effects on blood pressure levels or neurocognitive tests, although significant improvements in sleepiness were observed 69 . A secondary analysis of this trial among those >80 years did not find significant effects on sleepiness 70 . Among those that initiated PAP therapy, our study found greater beneficial effects of PAP utilization in those that are 65-69 years.…”

Section: Discussionmentioning

confidence: 61%

Positive Airway Pressure Therapy Predicts Lower Mortality and Major Adverse Cardiovascular Events Incidence in Medicare Beneficiaries with Obstructive Sleep Apnoea

Mazzotti

Waitman

Miller

et al. 2023

Preprint

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Background: Obesity is associated with obstructive sleep apnoea (OSA) and cardiovascular risk. Positive airway pressure (PAP) is the first line treatment for OSA, but evidence on its beneficial effect on major adverse cardiovascular events (MACE) prevention is limited. Using claims data, the effects of PAP on mortality and incidence of MACE among Medicare beneficiaries with OSA were examined. Methods: A cohort of beneficiaries (>65 years) with ≥5 years of consecutive enrolment to Medicare and ≥2 distinct OSA claims was defined from multi-state, state-wide, multi-year (2011-2017) Medicare fee-for-service claims data. Evidence of PAP initiation and utilisation was based on PAP claims after OSA diagnosis. MACE was defined as a composite of myocardial infarction, heart failure, stroke, or coronary revascularisation. Doubly robust Cox proportional hazards models with inverse probability of treatment weights estimated treatment effects controlling for sociodemographic and clinical factors. Results: Among 225,132 beneficiaries with OSA (median age 74 years; 45.3% women; median follow-up 3 years), those with evidence of PAP initiation (50.1%) had significantly lower all-cause mortality (HR [95%CI]: 0.57 [0.56-0.59]) and MACE incidence risk (0.90 [0.88-0.92]). Higher quartiles of annual PAP claims were progressively associated with lower mortality (Q2: 0.80 [0.75-0.86], Q3: 0.68 [0.64-0.72], Q4: 0.65 [0.61-0.70]) and MACE incidence risk (Q2: 0.91 [0.86-0.97], Q3: 0.87 [0.82-0.91], Q4: 0.85 [0.80-0.90]). Conclusion: PAP utilisation was associated with lower all-cause mortality and MACE incidence among Medicare beneficiaries with OSA. Results might inform trials assessing the importance of OSA therapy towards minimising cardiovascular risk and mortality in older adults.

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Section: Discussionmentioning

confidence: 61%

Positive Airway Pressure Therapy Predicts Lower Mortality and Major Adverse Cardiovascular Events Incidence in Medicare Beneficiaries with Obstructive Sleep Apnoea

Mazzotti

Waitman

Miller

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

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“…The authors have not included some relevant information about changes in the Epworth Sleepiness scale (ESS) as well as factors that are associated with the prognosis in terms of sleep-related symptoms and the quality of life [ 2 ]. In addition, they have ignored data regarding patients aged over 80 years.…”

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confidence: 99%

Adherence to Auto-CPAP and Age: A Stable Condition? Comment on Barroso et al. Influence of Age on Adherence to Auto-CPAP: Experience from a Sleep Center in Portugal. Adv. Respir. Med. 2022, 90, 143–147

Esquinas

2022

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Schlafstörungen im höheren Lebensalter und Relevanz assoziierter Probleme

Frohnhofen

Schlitzer²

2023

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Effect of continuous positive airway pressure in very elderly with moderate-to-severe obstructive sleep apnea pooled results from two multicenter randomized controlled trials

Cited by 9 publications

References 17 publications

Positive Airway Pressure Therapy Predicts Lower Mortality and Major Adverse Cardiovascular Events Incidence in Medicare Beneficiaries with Obstructive Sleep Apnoea

Positive Airway Pressure Therapy Predicts Lower Mortality and Major Adverse Cardiovascular Events Incidence in Medicare Beneficiaries with Obstructive Sleep Apnoea

Adherence to Auto-CPAP and Age: A Stable Condition? Comment on Barroso et al. Influence of Age on Adherence to Auto-CPAP: Experience from a Sleep Center in Portugal. Adv. Respir. Med. 2022, 90, 143–147

Schlafstörungen im höheren Lebensalter und Relevanz assoziierter Probleme

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