Continuous positive airway pressure and survival of very elderly persons with moderate to severe obstructive sleep apnea

Objective: There is evidence of a beneficial effect of long-term continuous positive airway pressure (CPAP) on survival in elderly persons with obstructive sleep apnea (OSA), although the usual age cut off is between 60 and 70 years of age. Our objective was to determine this effect in very elderly patients (ie, those >= 80 years of age). Methods: An observational study of a historic cohort of very elderly persons with moderate to severe OSA (apnea-hypopnea index >= 20) and the effect of long-term CPAP on their survival was performed. Two groups were formed: one prescribed CPAP treatment (>= 4 hours per night), and one without CPAP treatment. Survival analyses, including Kaplan-Meier curves and Cox models, were carried out to determine the association of long-term CPAP with longer survival, Results: A total of 155 very elderly persons (84 men and 71 women, mean age 81.5 +/- 1.5 years) were followed up for 53 months (interquartile range, 41-77 months); 83 deaths occurred. CPAP was prescribed to 132 patients, and adherence was observed in 79 (60%). Kaplan-Meier curves showed longer survival in the treated OSA group (91 months, 95% confidence interval [CI] = 76-106) than in the untreated OSA group (52 months, 95% CI 41-64), which was statistically significant (log-rank 16.9, p < 0.0001). Although history of stroke was significantly associated with higher mortality (hazard ratio [HR] = 2.18, 95% CI = 1.14-4.17, p = 0.02), CPAP treatment was associated with higher survival rates (HR = 0.46, 95% CI = 0.27-0.78, p = 0.004) in an adjusted Cox analysis. Conclusions: CPAP treatment might be associated with a longer survival in very elderly persons with moderate to severe OSA. (C) 2015 Elsevier B.V. All rights reserved.