Does PAP Help the Elderly?
A recent study published in the journal Sleep Medicine examined the use of CPAP in 97 patients over the age of 80. The results were not promising as the authors noted very few improvements in the sample other than decreasing snoring, witnessed apneas and the AHI. Other parameters such as improved blood pressure control, decreased anxiety and depression, even changes in daytime sleepiness failed to show significant benefits.
I find the methodology and the interpretation of this study highly suspect. First, the patients only used CPAP, a device I would never prescribe for someone 80 y/o. With their vulnerabilities or sensitivities, they should only receive more gentle PAP such as bilevel devices. Second, the patients could only average using CPAP 4.3 hours per night. That’s a terrible average, and with bilevel such patients almost always can average 6, 7 or 8 hours. Imagine declaring someone only using their medication 50% of the time and didn’t get any benefits from it? How shocked would you be? Third, no mention is made of nocturia (trips to the bathroom at night). Nocturia is arguably the single most important metric in any research of this study, because nocturia is one of it not the leading cause of falls in the elderly and often results in hospitalizations and death. And as a reminder, sleep apnea is probably the leading cause of nocturia in the elderly.
Why studies of this sort are able to pass ethical review standards without being criticized for their poor designs is something regularly observed in medical research. Basically, dumb designs yield dumb results.
This kind of study is known as an effectiveness-styled work, meaning if you take all-comers and don’t try too hard to get people to use the treatment, what kind of results will you find?
What’s needed here is efficacy-styled research. You want to help these people, who are probably suffering severe sleep disturbances given their average AHI was in the severe range (41 events/hour). So, do a study with a device they are likely to use like bilevel and don’t design the data collection for 3 months; check out how much things change in 6 to 12 months.
Lots of grant money goes to waste on these studies but worse patient care is set back, because now a lot of medical professionals will tell their elderly patients you don’t even need to try PAP. That’s plain stupid, because we’ve seen many 80 and 90 y/o patients using PAP regularly, night after night, all night long and clearly gaining enhanced quality of life on many dimensions.