Obstructive sleep apnea (OSA) is common and costly in older adults. In patients with OSA, the airway becomes partially or fully blocked during sleep, restricting oxygen supply to the brain and resulting in frequent cortical arousals. Untreated OSA increases the risk of cardiovascular diseases, metabolic syndromes, depression, reduced quality of life, and premature death and dramatically increases health care utilization and costs. Notably, OSA is a known risk factor for initial and repeat cerebrovascular events. Stroke is the fifth leading cause of death and disability in the United States and worldwide. 19 Indeed, the prevalence of co-morbid OSA among patients with stroke ranges from 50% to 70% and is highest among older adults.
The most commonly prescribed and studied treatment for OSA is continuous positive airway pressure (CPAP) therapy. CPAP is associated with improved health outcomes in multiple domains. Evidence has shown that CPAP can decrease mortality, improve cognition,and reduce hypertension among older adults. Further, among older adults, CPAP is associated with improvements in multiple domains of daytime function, including reduced fatigue, sleepiness, and depression and increased quality of life. Despite these benefits, many patients struggle to adjust to the therapy, resulting in
sub-optimal adherence comparable to adherence to treatment for other chronic diseases.
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