Do CPAP Benefits Differ in Older vs. Younger Patients with OSA?
SEATTLE, WA—Improvement in the Epworth Sleepiness Scale (ESS) did not differ between older and younger patients treated with continuous airway positive pressure (CPAP) for obstructive sleep apnea (OSA), investigators at SLEEP 2015 concluded.
“This helps answer the clinical question regarding the benefit older patients may have from CPAP therapy of OSA,” reported Kyoung Bin Im, MD, MS, from the Sleep Disorders Center at The University of Iowa, Iowa City, IA. “Older patients on CPAP have equal benefit to younger patients on CPAP.”
The investigators evaluated data from 88 patients with both mild and moderate-to-severe newly diagnosed OSA and categorized them into younger (<55 years) and older (≥65 years) age groups. The study's primary outcome was change in ESS score between the two groups. One of the inclusion criteria was patient-reported “fair” or “good” CPAP use.
At baseline, mean age was 45 years for the younger and 71 years for the older patients. Baseline ESS was higher in the younger vs older patients, 11.0 vs 8.1 (P<0.05), the investigators reported, adding that “younger patients had a higher rate of mood disorders,” 53% vs 18% (P<0.005). Average baseline AHI was 13.0 in the younger group and 17.2 in the older group (P<0.05); the older patients also had significantly more hypertension, 79% vs 55% (P<0.05).
Follow-up time was 4 months (124 days). Following CPAP therapy, there was a 37% reduction in ESS in both groups, -3.7 for the younger patients and -3.9 for the older patients, when adjusted for baseline ESS and average AHI.
By age, among younger patients, ESS decreased from 10.8 to 6.9 for those with mild OSA (n=31) and 11.1 to 6.6 for those with moderate-to-severe OSA (n=19). Among older patients, the decrease in ESS was 8.3 to 5.0 for those with mild OSA (n=14) and 7.8 to 5.6 for those with moderate-to-severe OSA (n=18).
“Higher baseline ESS In younger patients may be due to increased mood disorders,” Dr. Im noted; along with the co-occurrence of OSA and mood disorders, symptoms of depression, fatigue, and changes in sleep may overlap with the ESS questions.
These findings provoke questions “regarding other treatment outcomes in CPAP treated OSA for older adults,” they concluded.