Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment

Martínez‐García, Miguel Ángel; Chiner, Eusebi; Hernández, Luís; Cortes, Jose Pascual; Catalán, Pablo; Ponce, Silvia; Diaz, Jose; Pastor, Ester; Vigil, Laura; Carmona, Carmen; Montserrat, Josep M.; Aizpuru, Felipe; Lloberes, Patrícia; Mayos, Mercedes; Selma, María José; Cifuentes, Jose Fernando; Muñoz, A

doi:10.1183/09031936.00064214

Cited by 82 publications

(72 citation statements)

References 34 publications

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“…In six articles, the authors all reported that adherence was high and was often associated with greater improvement in the outcome measures but did not report actual hours of use. One study reported more modest usage (medians of 1 h 52 min to 2 h 22 min) but did not correlate the results with outcomes [61]. One study reported that acceptance rates were lower in older patients than younger patients, but there was no difference in the number of hours used within compliers [51].…”

Section: Adherencementioning

confidence: 96%

“…Of these nine studies, five were RCTs. Only three studies actually reported hours of PAP use [36,56,61], and this included one in patients with Alzheimer's disease who wore the PAP mask for an average of 4.8 h [36]. These authors also found that more depressive symptoms were associated with worse adherence [36].…”

Section: Adherencementioning

confidence: 98%

“…Of these nine, eight were RCTs and one was a controlled open study without randomisation. Seven of the nine studies showed that PAP treatment of OSA resulted in improvement of breathing or of sleep architecture and daytime sleepiness [35,37,38,[39][40][41]61]. One study found that there were no significant improvements in any of the outcome measures including daytime sleepiness [43].…”

Section: Effect On Sleep Apnoeamentioning

confidence: 99%

“…Five studies focused on PAP adherence [41,51,52,54,61]. An additional four studies reported adherence although it was not an outcome variable [37,38,43,56].…”

Section: Adherencementioning

confidence: 99%

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Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

et al. 2016

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Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulated via discussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group. @ERSpublications An overview of the research in the field of and clinical guidelines for the treatment of SDB in elderly patients

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Section: Adherencementioning

confidence: 96%

Section: Adherencementioning

confidence: 98%

Section: Effect On Sleep Apnoeamentioning

confidence: 99%

“…Five studies focused on PAP adherence [41,51,52,54,61]. An additional four studies reported adherence although it was not an outcome variable [37,38,43,56].…”

Section: Adherencementioning

confidence: 99%

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Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

et al. 2016

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“…15 Data also support an improvement of sleepiness symptoms in SDB with CPAP 16,17 and depressive symptoms also improve with CPAP in SDB in the general population. 11,[18][19][20] However, there are few studies which examine improvement of sleepiness and depressive symptoms in SDB in those with HTN. Furthermore, there is scant literature showing improvement of fatigue in patients with CPAP therapy, particularly those with HTN.…”

Section: Impact Of Sleep-disordered Breathing Treatment On Patient Rementioning

confidence: 99%

Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients

Walia

Griffith

Thompson

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: We hypothesized that patient reported outcomes (PROs) improve with positive airway pressure (PAP) in patients with sleep-disordered breathing (SDB) and hypertension (HTN). Methods: Questionnaire-based PROs (sleepiness [Epworth Sleepiness Scale, (ESS)], depression [Patient Health Questionnaire-9 (PHQ-9)], and fatigue [Fatigue Severity Scale (FSS)]) were retrospectively examined in patients with SDB and HTN at baseline and within a year following PAP initiation. PRO changes were estimated using multivariable linear mixed-effect models adjusted for baseline age, sex, race, body mass index, resistant hypertension (RHTN) status, cardiac and diabetes history, and correlation between repeated measurements. Age and race by PAP interaction terms (mean change, 95% CI) were examined. Results: 894 patients with HTN and SDB were examined. 130 (15%) had baseline RHTN (age 58 ± 12 y, 52.9 % male, BMI 36.2 ± 9.1 kg/m 2 ). In multivariable models, a significant improvement in sleepiness ESS (−2.09, 95% CI: −2.37, −1.82), PHQ-9 (−1.91, 95% CI: −2.25, −1.56), and FSS scores (−4.06 95% CI: −4.89, −3.22) was observed. A significant race by PAP effect interaction was observed (p < 0.0001 for all PROs); Caucasians had greater improvements than non-Caucasians. The interaction term of effect of PAP and age was significant for ESS (p = 0.04) and PHQ-9 (p = 0.0003), indicating greater improvement in younger patients. Conclusions: Consistent improvement of broad PRO domains in response to PAP in SDB was observed in this clinic-based hypertensive cohort; Caucasians and younger patients derived greater benefit. Keywords: patient reported outcomes, hypertension, positive airway pressure Citation: Walia HK, Griffith SD, Thompson NR, Moul DE, Foldvary-Schaefer N, Mehra R. Impact of sleep-disordered breathing treatment on patient reported outcomes in a clinic-based cohort of hypertensive patients.

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Screening for Obstructive Sleep Apnea in Adults

Jonas¹,

Amick²,

Feltner³

et al. 2022

JAMA

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ImportanceObstructive sleep apnea (OSA) is associated with adverse health outcomes.ObjectiveTo review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force.Data SourcesPubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022.Study SelectionEnglish-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores.Data Extraction and SynthesisDual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials.Main Outcomes and MeasuresTest accuracy, excessive daytime sleepiness, sleep-related and general health–related quality of life (QOL), and harms.ResultsEighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score &gt;10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, −2.33 [95% CI, −2.75 to −1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health–related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, −1.67 [95% CI, 2.09 to −1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg).Conclusions and RelevanceThe accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health–related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.

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Obstructive sleep apnoea in the elderly: role of continuous positive airway pressure treatment

Cited by 82 publications

References 34 publications

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

Impact of Sleep-Disordered Breathing Treatment on Patient Reported Outcomes in a Clinic-Based Cohort of Hypertensive Patients

Screening for Obstructive Sleep Apnea in Adults

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