Continuous positive airway pressure is effective at treating sleep apnoea in older people, a new study has found.
Obstructive sleep apnoea (OSA) is a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing and causing profound sleepiness. For people with moderate or severe OSA, doctors usually recommend using a continuous positive airway pressure (CPAP) device, which consists of a small pump that delivers pressurised air into the nose through a mask, stopping the throat from closing.
Previous studies have established the benefits of CPAP in 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 how sleepy patients feel in the daytime and reduces healthcare costs. The researchers say CPAP should be offered routinely to older patients with OSA, and more should be done to raise awareness of the condition.
The study, published today in Lancet Respiratory Medicine, involved 278 patients aged 65 or over at 14 NHS centres in the UK. It 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.
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 and their relatives 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.
Professor Mary Morrell, co-principal investigator of the study from the National Heart and Lung Institute at Imperial College London, said: "Sleep apnoea can be hugely damaging to patients' quality of life and increase their risk of road accidents, heart disease and other conditions. Lots of older people might benefit from this treatment. Many patients feel rejuvenated after using CPAP because they're able to sleep much better and it may even improve their brain function."
Patients with sleep apnoea sometimes stop breathing for 30 seconds or longer at night before they wake up and start breathing again. In these pauses, their blood oxygen levels fall.
"We think low oxygen levels at night might accelerate cognitive decline in old people, and studies have found that sleep apnoea causes changes in the grey matter in the brain. We're currently researching whether treatment can prevent or reverse those changes," said Professor Morrell.
Co-principal investigator Dr.Renata Riha, Consultant and Honorary Reader at the Royal Infirmary of Edinburgh, added that sleep medicine spans many disciplines and comprises an important area of research which deserves support and greater recognition by funding bodies, universities and public policy makers. "Sleep disorders, such as sleep apnoea, impact on a wide variety of chronic conditions, potentially leading to their development or worsening them, including diabetes, heart attacks, strokes and possibly even cancer. Successful treatment diminishes this risk but we still have a great deal of work to do in the area," she said.
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Notes to editors:
1. A. McMillan et al. 'Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial.' Lancet Respiratory Medicine, Published Online 25 August 2014. http://dx.doi.org/10.1016/S2213-2600(14)70172-9
2. Understanding Obstructive Sleep Apnoea (HD) | A film by the Wellcome Trust https://www.youtube.com/watch?v=HlRbpDBJRtI
3. About Imperial College London
Consistently rated amongst the world's best universities, Imperial College London is a science-based institution with a reputation for excellence in teaching and research that attracts 14,000 students and 6,000 staff of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and business, delivering practical solutions that improve quality of life and the environment - underpinned by a dynamic enterprise culture.
Since its foundation in 1907, Imperial's contributions to society have included the discovery of penicillin, the development of holography and the foundations of fibre optics. This commitment to the application of research for the benefit of all continues today, with current focuses including interdisciplinary collaborations to improve global health, tackle climate change, develop sustainable sources of energy and address security challenges.
In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science Centre. This unique partnership aims to improve the quality of life of patients and populations by taking new discoveries and translating them into new therapies as quickly as possible.
4. About the National Institute for Health Research
The National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme funds research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 700 issues published to date. The journal's 2013 Impact Factor (5.116) ranked it two out of 85 publications in the Health Care Sciences and Services category. All issues are available for download, free of charge, from the website. The HTA Programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales, and the HSC R&D Division, Public Health Agency in Northern Ireland. http://www.nets.nihr.ac.uk/programmes/hta
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (http://www.nihr.ac.uk).
This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
5. About the University of York
The University of York was founded in 1963 with 200 students. It now has nearly16,000 students and more than 30 academic departments and research centres.
It is a member of the Russell Group and features regularly in the ranks of the UK's foremost universities. The 2013 Times Higher Education ranked York as one of the world's top 100 universities.
It was named Times Higher Education University of the Year in 2010 for its drive to combine academic excellence with social inclusion, and its record in scientific discovery and investment in the arts and humanities. The University has won five Queen's Anniversary Prizes for the quality of its research.
The University of York places equal emphasis on research and teaching. Students in every department -¬ both undergraduate and postgraduate - are taught and advised by leaders in their field.
6. About the Royal Infirmary of Edinburgh
The Royal Infirmary of Edinburgh is a major acute teaching hospital. With a 24-hour accident and emergency department, it provides a full range of acute medical and surgical services for patients from across Lothian and specialist services for people from across the south east of Scotland and beyond.
The £190 million hospital opened in 2003 as a modern, purpose-built replacement for the old and out-dated Victorian building at Lauriston Place, and has more than 900 inpatient beds. It is home to Scotland's biggest maternity unit - some 6000 babies are born at the RIE's Simpson Centre for Reproductive Health each year - and Scotland's busiest A&E department.
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