Age-related differences in symptomatic CPAP efficacy in OSA patients

Limited data suggest a stronger association between apnea-hypopnea index (AHI) and sleepiness and a larger impact of continuous positive airway pressure (CPAP) on symptoms in younger patients. We aimed to evaluate the impact of 6 months treatment with CPAP on sleepiness and quality of life according to age in a large prospective clinical cohort of patients adherent to treatment.

Within the multicenter IRSR Pays de la Loire Sleep Cohort, we identified PAP adherent obstructive sleep apnea patients (mean use > 4h/days at 6 months follow-up). Univariate and multivariate linear regression models were used to assess predictors of a change in the Epworth Sleepiness Scale (ESS) score, SF-S6 and Pichot score (difference between score at 6-month follow-up and at inclusion).

In response to CPAP treatment, the ESS score significantly decreased compared to baseline by 3.9 (95% CI, 3.7,4.1) in the 3298 included patients. In the univariate analysis, the baseline values of age, body mass index (BMI), AHI and ESS were associated with changes in ESS score. In the multivariate analysis, the association between age and changes in ESS score remained significant after adjustments on BMI, sex, comorbidities, CPAP adherence and AHI (Coef. [95% CI] 0.062 [0.048, 0.076], p < 0.001) but not after further adjustment on baseline ESS. The impact of CPAP on fatigue and depression symptoms was stronger in younger patients and persisted after further adjustments.

In real-world settings, younger patients experienced a more pronounced impact of CPAP treatment on sleepiness and quality of life compared to older patients partly attributable to a lower baseline level of sleepiness in older age groups.