Respiratory Dept, Hospital Universitario y Politécnico La Fe, Valencia, Spain CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Bunyola, Spain
Respiratory Dept, Hospital Universitario San Juan, Alicante, Spain.
Eur Respir J. 2015 Jul;46(1):142-51. doi: 10.1183/09031936.00064214. Epub 2015 May 28.
Almost all the information about the effect of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnoea (OSA) comes from clinical trials involving only middle-aged patients. The objective of this study was to assess the effect of CPAP treatment in elderly patients with severe OSA on clinical, quality-of-life and neurocognitive spheres. We performed an open-label, randomised, multicentre clinical trial in a consecutive clinical cohort of 224 elderly (≥70 years old) patients with confirmed severe OSA (apnoea-hypopnea index ≥30) randomised to receive CPAP (n=115) or no CPAP (n=109) for 3 months. A sleep study was performed by either full polysomnography or respiratory polygraphy. CPAP titration was performed by an autoCPAP device. The primary endpoint was quality of life (Quebec Sleep Questionnaire) and secondary endpoints included sleep-related symptoms, presence of anxiety/depression, office-based blood pressure and some neurocognitive tests. The mean±sd age was 75.5±3.9 years. The CPAP group achieved a greater improvement in all quality-of-life domains (p<0.001; effect size: 0.41-0.98), sleep-related symptoms (p<0.001; effect size 0.31-0.91) as well as anxiety (p=0.016; effect size 0.51) and depression (p<0.001; effect size: 0.28) indexes and some neurocognitive tests (digit symbol test (p=0.047; effect size: 0.20) and Trail Making Test A (p=0.029; effect size: 0.44)) in an intention-to-treat analysis. In conclusion, CPAP treatment resulted in an improvement in quality of life, sleep-related symptoms, anxiety and depression indexes and some neurocognitive aspects in elderly people with severe OSA.
几乎所有关于持续气道正压通气（CPAP）治疗阻塞性睡眠呼吸暂停（OSA）患者效果的信息均来自仅涉及中年患者的临床试验。本研究的目的是评估 CPAP 治疗对老年重度 OSA 患者在临床、生活质量和神经认知领域的影响。我们对 224 例确诊的重度 OSA（呼吸暂停低通气指数≥30）老年患者（≥70 岁）进行了一项开放标签、随机、多中心临床试验，患者连续就诊，随机分为 CPAP 治疗组（n=115）或对照组（n=109），治疗时长为 3 个月。睡眠研究通过全夜多导睡眠图或呼吸描记术进行。CPAP 滴定通过自动 CPAP 设备进行。主要终点为生活质量（魁北克睡眠问卷），次要终点包括睡眠相关症状、焦虑/抑郁的存在、诊室血压和一些神经认知测试。患者平均年龄为 75.5±3.9 岁。CPAP 组在所有生活质量领域（p<0.001；效应量：0.41-0.98）、睡眠相关症状（p<0.001；效应量 0.31-0.91）、焦虑（p=0.016；效应量 0.51）和抑郁（p<0.001；效应量：0.28）指数以及一些神经认知测试（数字符号测试（p=0.047；效应量：0.20）和连线测试 A（p=0.029；效应量：0.44））均取得了更大的改善，这些均为意向性治疗分析结果。综上所述，CPAP 治疗可改善老年重度 OSA 患者的生活质量、睡眠相关症状、焦虑和抑郁指数以及一些神经认知方面。
