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Medline ® Abstract for Reference 111

of 'Sleep-wake disturbances and sleep disorders in patients with dementia'

Continuous positive airway pressure treatment for sleep apnea in older adults.
Weaver TE, Chasens ER
Sleep Med Rev. 2007 Apr;11(2):99-111. Epub 2007 Feb 1.
Daytime sleepiness and sleep disordered breathing are increased in older compared to middle-aged adults. The cognitive and cardiovascular sequelae associated with obstructive sleep apnea (OSA) have significant implications for the older adult who may already be suffering from chronic illness. Most of the evidence supporting the utilization of continuous positive airway pressure (CPAP) for the treatment of OSA has been generated from studies employing samples consisting predominately of middle-aged adults. To examine the efficacy of CPAP for the treatment of obstructive sleep apnea in older adults with an emphasis on adherence and related treatment outcomes, this paper reviews findings from clinical trials including older individuals as well as those specifically targeting this population. These studies have demonstrated that following CPAP therapy, older adults have increased alertness, improved neurobehavioral outcomes in cognitive processing, memory, and executive function, decreased sleep disruption from nocturia and a positive effect on factors affecting cardiac function, including vascular resistance, platelet coagulability and other aspects of cardiovascular health. Physiological differences in respiratory structure and function between younger and older adults ofsimilar disease severity are believed to result in older individuals requiring titration at lower CPAP levels. Once initiated, CPAP treatment is tolerated by older adults, including those with Alzheimer's disease. Patterns of adherence in older individuals are consistent with that of middle-aged adults.
Biobehavioral and Health Sciences Division, School of Nursing, Division of Sleep Medicine, Department of Medicine, School of Medicine, University of Pennsylvania, Nursing Education Building, Philadelphia, PA 19104-6096, USA. tew@nursing.upenn.edu