How Adherent Are Older Adults With MCI to CPAP Therapy?

SEATTLE, WA—Older adults with mild cognitive impairment (MCI) have an adherence to continuous positive airway pressure (CPAP) that is “comparable to that of reported values in other adult populations,” researchers presented at SLEEP 2015.

Although treatment of obstructive sleep apnea (OSA), a prevalent comorbid condition in older adults with MCI, has the potential to delay cognitive decline, “there is no information on whether older adults with MCI will adhere to CPAP or its effect on cognition over the long-term,” noted Kathy C. Richards, PhD, RN, of George Mason University, Fairfax, VA, in explaining the rationale for the study.

Specifically, MEMORIES (Mild Cognitive Impairment and Obstructive Sleep Apnea), a pilot clinical trial on the effect of CPAP on cognitive and everyday function in older adults with MCI, sought to determine 6-month and 1-year objectively measured adherence to CPAP.

Participants were included if they had OSA, were 55–90 years of age, had an apnea-hypopnea index (AHI) ≥10, amnestic MCI using established diagnostic criteria, and clinical response to CPAP, as evidenced by AHI <5 following optimal pressure during titration polysomnography. MEMORIES recruited 59 participants from sleep, primary care, and geriatric clinics. Mean age was 77.8 years (SD 8.20), and mean Mini-Mental State Examination (MMSE) score was 28.1 (SD 1.70).

Of the 59 patients, nine (15%) elected not to try CPAP. This group was significantly older (mean age 77.8 years; SD 8.20) than the group who chose to try CPAP (mean age 68.5 years; SD 7.30). Sex, race, education, or MMSE did not differ between the two groups.

At 6 months, mean hours of daily CPAP use for the group that elected to try CPAP was 4.98 hours/night, (SD 2.39) and, at 1 year, 4.93 hours/night (SD 2.54). At both the 6-month and 1-year time points, 64% of this group averaged ≥4 hours per night of CPAP use.

Dr. Richards added that some potential CPAP adherence intervention methods can include: education regarding OSA, CPAP, risks, and treatment expectations; promotion of a positive initial CPAP experience; motivational interviewing to reinforce individual health-related goals and self-efficacy; anticipatory guidance regarding common problems with CPAP; social support through inclusion of a study partner.

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