Trzepizur Wojciech, Moreau Clémence, Meslier Nicole, Goupil François, Pigeanne Thierry, Gagnadoux Frédéric
Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.
INSERM Unit 1063, MITOVASC, Equipe CarME, Angers, France.
Sleep. 2025 Aug 14;48(8). doi: 10.1093/sleep/zsaf108.
Limited data suggest a stronger association between apnea-hypopnea index (AHI) and sleepiness and a larger impact of continuous positive airway pressure (CPAP) on symptoms in younger patients. We aimed to evaluate the impact of 6 months treatment with CPAP on sleepiness and quality of life according to age in a large prospective clinical cohort of patients adherent to treatment.
Within the multicenter IRSR Pays de la Loire Sleep Cohort, we identified PAP adherent obstructive sleep apnea patients (mean use > 4h/days at 6 months follow-up). Univariate and multivariate linear regression models were used to assess predictors of a change in the Epworth Sleepiness Scale (ESS) score, SF-S6 and Pichot score (difference between score at 6-month follow-up and at inclusion).
In response to CPAP treatment, the ESS score significantly decreased compared to baseline by 3.9 (95% CI, 3.7,4.1) in the 3298 included patients. In the univariate analysis, the baseline values of age, body mass index (BMI), AHI and ESS were associated with changes in ESS score. In the multivariate analysis, the association between age and changes in ESS score remained significant after adjustments on BMI, sex, comorbidities, CPAP adherence and AHI (Coef. [95% CI] 0.062 [0.048, 0.076], p < 0.001) but not after further adjustment on baseline ESS. The impact of CPAP on fatigue and depression symptoms was stronger in younger patients and persisted after further adjustments.
In real-world settings, younger patients experienced a more pronounced impact of CPAP treatment on sleepiness and quality of life compared to older patients partly attributable to a lower baseline level of sleepiness in older age groups.
有限的数据表明，呼吸暂停低通气指数（AHI）与嗜睡之间的关联更强，持续气道正压通气（CPAP）对年轻患者症状的影响更大。我们旨在评估在一个坚持治疗的大型前瞻性临床队列中，根据年龄，CPAP治疗6个月对嗜睡和生活质量的影响。
在多中心卢瓦尔河地区IRSR睡眠队列中，我们确定了坚持使用 PAP 的阻塞性睡眠呼吸暂停患者（在6个月随访时平均使用时间>4小时/天）。使用单变量和多变量线性回归模型来评估 Epworth 嗜睡量表（ESS）评分、SF-S6和皮肖评分变化的预测因素（6个月随访时的评分与纳入时的评分之差）。
在纳入的3298例患者中，与基线相比，CPAP治疗后ESS评分显著降低3.9（95%CI，3.7,4.1）。在单变量分析中，年龄、体重指数（BMI）、AHI和ESS的基线值与ESS评分变化相关。在多变量分析中，在对BMI、性别、合并症、CPAP依从性和AHI进行调整后，年龄与ESS评分变化之间的关联仍然显著（系数[95%CI]0.062[0.048,0.076]，p<0.001），但在对基线ESS进行进一步调整后不再显著。CPAP对年轻患者疲劳和抑郁症状的影响更强，在进一步调整后仍然存在。
在现实环境中，与老年患者相比，年轻患者CPAP治疗对嗜睡和生活质量的影响更为显著，部分原因是老年组的基线嗜睡水平较低。
