Long-term CPAP adherence in elderly patients after ambulatory initiation

Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA), yet long-term adherence, especially in elderly populations remains underexplored. This study evaluated CPAP adherence at 3 months, 1 year, and 2 years in patients aged ≥ 65 years with severe OSA (apnea-hypopnea index ≥ 30/h) managed via ambulatory auto-CPAP initiation.

We conducted a retrospective monocentric study at CHU UCL Namur Godinne. 45 patients aged ≥ 65 years were included between January 2020 and December 2021. Good CPAP adherence was set at ≥ 4 h/day (h/d) of usage. Clinical and technical variables, including Epworth Sleepiness Scale (ESS) and subjective improvement, were analyzed for their association with adherence.

45 patients (31 males), aged (median and IQR) 69.0 (66.0-72.0) years old, BMI: 31 (28-35) kg/m², Epworth Sleepiness Scale 8.0 (5.00-11.00) and having severe OSA (OAHI 50/h; 42-64) were studied. At 3 months, 78% of patients were adherent (median use 6.75 h/d [5.00-8.12]), 80% at 1 year (6.34 h/d [5.48-8.02]), and 64% at 2 years (6.35 h/d [5.03-8.06]). A good adherence at 3 months and 1 year, a lower baseline ESS and higher perceived benefit were significantly associated with adherence at 2 years.

In our elderly population with severe OSA, there was a drop of adherent patients (≥4 h/d) at two years but among patients who used the CPAP, a good mean CPAP use in h/d was achieved at two years. A good adherence at the first visit at 3 months, 1 year, a low baseline ESS and subjective benefits appear to influence long-term adherence more than initial age.