The PREDICT trial results have shown that continuous positive airway pressure can reduce sleepiness in older people with obstructive sleep apnoea syndrome. This treatment is also likely to be cost-effective, so researchers are recommending that it should be offered routinely to older patients with moderate to severe obstructive sleep apnoea syndrome.
Obstructive sleep apnoea (OSA) syndrome is a condition where the airways close up for short periods during sleep, interrupting normal breathing and waking the sleeper. This causes profound daytime sleepiness. OSA is usually accompanied by loud snoring. Sleep apnoea can be very damaging to patients’ quality of life and increase their risk of road accidents, heart disease and other conditions.
For people with moderate or severe OSA, doctors usually recommend using a continuous positive airway pressure (CPAP) device while sleeping. This consists of a small pump that delivers pressurised air into the nose through a mask, stopping the throat from closing.
Previous studies have shown that CPAP does help middle-aged people with OSA, but until now there has been no research on whether the treatment is useful and cost-effective for older patients. The new research found that CPAP reduces daytime sleepiness in this patient population and reduces healthcare costs for the NHS.
The study, published today in The Lancet Respiratory Medicine, involved 278 patients aged 65 or over at 14 NHS centres in the UK. Patients were randomly allocated to receive either CPAP plus advice on how to minimise daytime sleepiness, or just advice. Those who received CPAP were less sleepy after 3 and 12 months than those who received only the advice. The difference was greater in those with more severe OSA at the start of the trial.
Around 20 per cent of the adult population experiences breathing problems during sleep. In four to five per cent of middle-aged people, these problems lead to sleepiness in the daytime, classified as obstructive sleep apnoea syndrome. The condition is thought to be more common in older people, but the true prevalence is unknown, in part because patients may attribute their sleepiness to old age, or older people can compensate by napping. The disease is becoming more common because obesity is a major risk factor. Many older people could benefit from this treatment.
The PREDICT study was led by researchers at Imperial College London and the Royal Infirmary of Edinburgh in collaboration with the Medical Research Council Clinical Trials Unit at UCL, and the Universities of Oxford and York. It was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme.