During sleep, soft tissue in the throat and mouth relax and can block the airway. When this causes temporary pauses in breathing during sleep it is called obstructive sleep apnea (OSA). OSA causes poor sleep which not only leads to fatigue, but may also contribute to chronic illnesses such as obesity, high blood pressure, and diabetes. While these side effects can be harmful at any age they may be more detrimental to the health of older adults since they are more prone to sleep issues as well as chronic issues like high blood pressure and weight gain.
Continuous positive airway pressure (CPAP) is an OSA treatment that helps keep the airway open during sleep. While many studies have shown the effectiveness of CPAP to treat OSA, very few have focused on the effectiveness of CPAP for older adults. Two separate trials were done to look for benefits of CPAP in older adults with OSA. The trials, published in Health Technology Assessment and European Respiratory Journal, found that CPAP can reduce next day sleepiness and improve quality of life in older adults with OSA.
About the Study
One randomized trial included 278 adults aged 65 or older with newly diagnosed OSA who were randomized to CPAP or no CPAP for 12 months. All participants also received a booklet on habits for better sleep. Participants filled out a survey on daytime sleepiness at start and end of trial. At 12 months, Compared to no treatment, participants that had CPAP reported:
- Greater reduction in daytime sleepiness
- Improvement in sleep specific quality of life (at 3 months and 12 months)
There was no significant difference in daytime mood, function, accidents, cognitive function, or cardiovascular events.
A second trial included 224 participants aged 70 years or older with severe OSA who were randomized to CPAP or no CPAP for 3 months. Only about 70% reported using CPAP for 4 hours or more per night. At 3 months, CPAP was associated with improvement in:
- Sleep-related quality of life
- Sleep symptoms such as snoring and pauses in breathing
- Anxiety
- Depression
There were no significant differences in blood pressure changes.
How Does this Affect You?
A randomized trial is considered the most reliable form of research, but how the research is done will affect its reliability. The first trial had some limits in how it analyzed the data which may make it less reliable. In the second trial, there was a problem in compliance with treatment since only 70% used CPAP as expected. The participants who did not properly do treatment were still included in the analysis which may decrease the true affect of treatment. The second trial was also focused on those with severe OSA. It may not be clear if the benefits would be present for those with more mild OSA.
CPAP has strong evidence that supports its use to manage OSA. These studies suggest that the benefits do extend to older adults. If you are having problems like still feeling tired after waking up, drowsiness during the day, or pauses in breathing, choking, or excessive snoring during the night, talk to your doctor about options for better sleep. If you are currently using a CPAP, using it as recommended is important to get the greatest benefits.
RESOURCES
Family Doctor—American Academy of Family Physicians http://familydoctor.org
National Sleep Foundation http://sleepfoundation.org
References
Continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 5, 2015. Accessed October 29, 2015.
McMillan A, Bratton DJ, et al. A multicentre randomised controlled trial and economic evaluation of continuous positive airway pressure for the treatment of obstructive sleep apnoea syndrome in older people: PREDICT. Health Technol Assess. 2015 Jun;19(40):1-188. Available at: http://www.journalslibrary.nihr.ac.uk/%5F%5Fdata/assets/pdf%5Ffile/0008/146096/FullReport-hta19400.pdf. Accessed October 29, 2015.