• Gonzalo Labarca, Daniela Saavedra, Jorge Dreyse, Jorge Jorquera, and Ferran Barbe.
• Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile. Electronic address: glabarcat@gmail.com.
• Chest. 2020 Aug 1; 158 (2): 751-764.

BackgroundOSA is found commonly in the elderly population (≥65 years old), and CPAP improves sleepiness and health-related quality of life (HRQoL) in the middle-aged population; however, data about its efficacy in elderly patients are unclear. The purpose of this study was to evaluate the efficacy of CPAP for sleepiness, HRQoL, mood, and cognition in elderly patients with OSA.Research QuestionIn elderly patients (≥65 years old) with OSA, is CPAP, compared with usual care or sham CPAP, effective at improving sleepiness, HRQoL, mood, and neurocognitive function?Study Design And MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials that included trials performed in elderly patients with OSA. As an intervention, we compared CPAP vs a control group. Two independent reviewers explored several databases; risk of bias (RoB) was evaluated with the Cochrane tool. Changes in sleepiness (Epworth Sleepiness Scale), HRQoL (Quebec Sleep Questionnaire), mood (Hospital Anxiety-Depression Scale), and neurocognitive tests after treatment were the outcomes. The meta-analysis was conducted according to the DerSimonian-Laird method, and the quality of evidence was rated according to the GRADE guidelines.ResultsA total of 4 randomized controlled trials (680 participants) were included. RoB was high for performance and detection bias. CPAP was associated with a 2.62-point improvement in the Epworth Sleepiness Scale (1.93 to 3.30; I2 = 52%). All domains of the Quebec Sleep Questionnaire were improved: hypersomnolence, 0.67 points (0.31 to 1.03; I2 = 75%); diurnal symptoms, -0.71 points (-0.98 to -0.44; I2 = 58%); nocturnal symptoms, 1.09 points (0.9 to 1.27; I2 = 9%); emotions, 0.45 points (0.30 to 0.61; I2 = 11%); and social interaction, 0.55 points (0.1 to 0.99; I2 = 82%). CPAP also improved the Hospital Anxiety-Depression Scale depression domain, and there were reports of a slight improvement in neurocognitive tests. The quality of evidence was low and very low for all outcomes.InterpretationAlthough CPAP therapy reportedly results in important clinical differences in sleepiness, HRQoL, and mood and a slight improvement in neurocognitive tests, concerns regarding the RoB and quality of the evidence do not support the benefit in all patients.Trial RegisterPROSPERO ID CRD42019146947.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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