Table 7.

Some messages with clinical implications about obstructive sleep apnoea (OSA) and CPAP treatment in the elderly

OSA prevalence increases with age

Since it is not known what is the cut off in the apnoea-hypopnoea index and Epworth sleepiness scale that should be considered as pathological, it should be used as in younger individuals

A clinical history that includes findings specific to elderly people must be always undertaken

Sleepiness must not be considered a physiological situation in elderly. However it is not be assumed that it must be associated to OSA

The clinical picture of OSA in elderly is different than that seen in younger patients. Neurocognitive symptoms are especially prevalent

Full polysomnography is the gold standard in the diagnosis of OSA in elderly. However simplified tests can be used in patients without important comorbidities.

Randomized clinical trials demonstrated that CPAP is effective in symptomatic moderate to severe OSA patients

It is not known what happens in extreme old age (over 80 years) when the compliance to CPAP is very low, therefore a less aggressive approach may be appropriate when recommending treatment with CPAP