Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_41_библиотеки_им_акад_М_И_Перельмана

Continuous positive airway pressure (CPAP) therapy is the gold standard treat­ment for OSA.CPAP devices essentially use air to stent open the upper airway in order to combat airway obstruction. The vast majority of trials of CPAP therapy have focused on patients who are middle-aged. Only recently have there been ran­domized controlled trials focused on CPAP therapy in older individuals. The PREDICT trial comprised of 231 patients and found that CPAP improved subjective sleepiness and was cost-effective in patients aged greater than 65years [18]. A simi­larly sized study in Spain among patients with severe OSA over the age of 70years found that CPAP improved quality of life, mood, and some indices of neurocogni­tive function [19]. A smaller pilot study found that CPAP improved episodic and short-term memory as well as executive functioning with a suggestion of increased connectivity on neuroimaging [20]. A larger study to extrapolate these results to moderate OSA failed to show the same neurocognitive benets but did show that sleepiness and quality of life were improved on CPAP in those older than 70years of age [21]. Observational studies have suggested that CPAP is well-tolerated and may have a mortality benet in older patients including in those over the age of 80 [22]. Studies on whether CPAP adherence is better or worse in an older population have had mixed results, and any changes in CPAP adherence with age may be due to factors other than advancing age [23]. CPAP has been found to be well-tolerated and benecial in patients with mild to moderate Alzheimer’s disease [24]. Age alone should not be a barrier to the testing for and treatment of OSA.Even the presence of dementia should not preclude using CPAP for OSA.