Continuous positive airway pressure treatment for sleep apnea in elderly patients systematic review and meta-analysis

The purpose of this study was to review the literature of the last 10 years (published in 2015-2024), in order to evaluate the effect of continuous positive airway pressure (CPAP) treatment on obstructive sleep apnea (OSA) among the elderly.

We conducted a meta-analysis of studies evaluating CPAP vs. usual care in patients more than 65 years with moderate to severe OSA. Our outcomes were changes in ESS (Epworth Sleepiness Scale), neurocognitive tests, Sleep-related Quality of Life (QSQ), and mortality.

We identified 229 studies from various databases, including 13 with 14,880 participants in our analysis. CPAP significantly was associated with improvement of sleepiness, anxiety and depression according to the effect size of -2.92, 0.2 and 0.35 respectively (CI: -3.82 to -2.03, 0.02 to 0.38, 0.03 to 0.67). The digit span and digit symbol were improved in the CPAP group by the small effect size of 0.19 and 0.24 respectively. (CI: 0.01 to 0.36, 0.06 to 0.41). Also mortality and diurnal symptoms were reduced with the moderate effect size of 0.64 and 0.61 respectively in the CPAP group. (CI: 0.52 to 0.75, 0.42 to 0.79).

CPAP significantly impacts daytime sleepiness, sleep-related quality of life, cognitive functions, and mortality in elderly individuals. Benefits are particularly evident in consistent users over four hours, especially regarding daytime sleepiness. Larger, well-structured randomized controlled trials involving compliant patients are crucial to provide robust evidence on CPAP effects in elderly populations, considering age-related comorbidities, cognitive performance, and neuropsychological issues.