Oral Appliance Therapy More Helpful than CPAP for Older Adults with Sleep Apnea, Research Shows

A rather surprising study came out last year, suggesting that CPAP might not be especially helpful for elderly adults with moderate to severe obstructive sleep apnea (OSA).

Even though CPAP-users over the age of 70 showed significantly improved snoring and AHI scores, no clinical improvement was seen in daytime sleepiness, quality of life, neurocognitive function, OSA-related symptoms, depression, anxiety, or blood pressure. (“AHI” stands for “apnea-hypopnea index,” which reflects the number of times a person stops breathing during an average hour of sleep. Five to 15 episodes is considered mild; 15 to 30, moderate; over 30, severe.)

“The present study,” concluded the researchers, “does not support the use of CPAP in very elderly patients with moderate-to-severe OSA.”

But that doesn’t mean that older adults with sleep apnea are just out of luck. Research presented at this year’s CHEST conference of the American College of Chest Physicians suggests that oral appliance therapy can provide the kind of benefits that CPAP can’t.

Through a battery of tests, 57 adults over the age of 65 were diagnosed with OSA. Most of them had mild to moderate apnea, with a median AHI of 9.6, while 6 had severe apnea, with a median AHI of 35.8. Twenty-five patients chose appliance therapy due to CPAP intolerance and three used it as a CPAP alternative. The rest chose appliance therapy from personal preference.

Nearly three-quarters of the patients underwent followup testing, and those test results were impressive.

Roughly half of the patients in both groups saw their AHI scores drop more than 50%. Even better, their daytime sleepiness improved. For those in the mild/moderate group, the median Epworth Sleepiness Scale score dropped from 5 to 7. In the severe group, the median score drop was from 6.5 to 4.5.

The study authors thus concluded that

Oral appliance treatment for both mild-to-moderate and severe OSA in elderly adults is tolerable and effective in patients who do not have contraindication for this treatment.

That’s impressive – and promising for any older adult with apnea, especially those who struggle with CPAP. Many seniors do, for a variety of reasons:

  • Discomfort from the mask or pressure: The CPAP mask and pressurized air can feel uncomfortable, claustrophobic, or disruptive to sleep. These effects may be amplified for older adults.
  • Cognitive changes: Some older adults experience declines in cognition or memory which can make it harder to understand, operate, or maintain consistent CPAP use.
  • Physical impediments: Age-related structural changes in facial or airway structure, or conditions like arthritis can interfere with mask fitting and make it hard to tolerate pressures.

These are non-issues with oral appliance therapy, which works by simply holding the jaw forward in a more optimal position, keeping the airway open so you can breathe continuously and effortlessly throughout the night.

Here’s what one of Dr. Abdulla’s own patients had to say after shifting from CPAP to sleeping with an oral appliance:

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