We have read with great interest the recent paper published by Barroso et al. entitled “Influence of Age on Adherence to Auto-CPAP: Experience from a Sleep Center in Portugal”. This interesting study revealed that patients over 65 years of age have adequate adherence to CPAP treatment [1]. However, although this study is in line with other studies published, we feel that there are some points that should be considered for correct interpretation of the results.
The authors have not included some relevant information about changes in the Epworth Sleepiness scale (ESS) as well as factors that are associated with the prognosis in terms of sleep-related symptoms and the quality of life [2]. In addition, they have ignored data regarding patients aged over 80 years. From a neurological point of view, some authors have found no differences in the use of CPAP and have not demonstrated any effect on any neurocognitive tests (including anxiety and depression) [3]. Another important aspect that would be nice to know is whether the authors consider that the patients need educational, supportive, and behavioral interventions to maintain adherence to CPAP in the long term [4]. Moreover, providing information regarding the correlation between the socioeconomic conditions of patients and adherence to CPAP could have been useful. [5] In addition, the authors could have compared their results with other geographical areas of Portugal as there may be a geographical factor, and it would be interesting to see how the geographic factor affects the results [6]. Finally, the authors stated in the limitations of their study that they do not know which different APAP models, as well as interfaces, could be adapted. In addition to the limitations they indicated, we think it would be appropriate for the authors to state that OSA phenotypes are also important in PAP adherence [7].
We believe that future studies on adherence to CPAP in patients >65 years of age could establish other non-respiratory factors regarding their capacity for adherence stability and accessibility to this type of CPAP treatment.
Conflicts of Interest
The authors declare no conflict of interest.
Funding Statement
This research received no external funding.
Footnotes
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Barroso A., Carrondo M.C., Moita J. Influence of age on adherence to auto-CPAP: Experience from a sleep center in Portugal. Adv. Respir. Med. 2022;90:143–147. doi: 10.5603/ARM.a2022.0014. [DOI] [PubMed] [Google Scholar]
- 2.Martinez-Garcia M.A., Oscullo G., Ponce S., Pastor E., Orosa B., Catalán P., Martinez A., Hernandez L., Muriel A., Chiner E., et al. Effect of continuous positive airway pressure in very elderly with moderate-to-severe obstructive sleep apnea pooled results from two multicenter randomized controlled trials. Sleep Med. 2022;89:71–77. doi: 10.1016/j.sleep.2021.11.009. [DOI] [PubMed] [Google Scholar]
- 3.Ponce S., Pastor E., Orosa B., Oscullo G., Catalán P., Martinez A., Hernández L., Muriel A., Chiner E., Martínez-García M.Á. The role of CPAP treatment in elderly patients with moderate obstructive sleep apnoea: A multicentre randomised controlled trial. Eur. Respir. J. 2019;54:1900518. doi: 10.1183/13993003.00518-2019. [DOI] [PubMed] [Google Scholar]
- 4.Wozniak D.R., Lasserson T.J., Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst. Rev. 2014;1:CD007736. doi: 10.1002/14651858.CD007736.pub2. [DOI] [PubMed] [Google Scholar]
- 5.Grote L., Theorell-Haglöw J., Ljunggren M., Sundh J., Midgren B., Ekström M. Socioeconomic Factors and Adherence to CPAP: The Population-Based Course of Disease in Patients Reported to the Swedish CPAP Oxygen and Ventilator Registry Study Andreas Palm. Chest. 2021;160:1481–1491. doi: 10.1016/j.chest.2021.04.064. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Dunietz G.L., Yu Y., Levine R.S., Conceicao A.S., Burke J.F., Chervin R.D., Braley T.J. Obstructive sleep apnea in older adults: Geographic disparities in PAP treatment and adherence. J. Clin. Sleep Med. 2021;17:421–427. doi: 10.5664/jcsm.8914. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Zinchuk A.V., Gentry M.J., Concato J., Yaggi H.K. Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches. Sleep Med. Rev. 2017;35:113–123. doi: 10.1016/j.smrv.2016.10.002. [DOI] [PMC free article] [PubMed] [Google Scholar]