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. 2023 Oct 9;78(10):1861-1870.
doi: 10.1093/gerona/glad099.

Predictors of Adherence to Continuous Positive Airway Pressure in Older Adults With Apnea and Amnestic Mild Cognitive Impairment

Kathy C Richards  1 , Alicia J Lozano  2 , Jennifer Morris  3 , Stephen T Moelter  4 , Wenyan Ji  2 , Vani Vallabhaneni  5 , Yanyan Wang  6 , Luqi Chi  7   8 , Eric M Davis  9 , Cindy Cheng  10 , Vanessa Aguilar  1 , Sneha Khan  11 , Mira Sankhavaram  1 , Alexandra L Hanlon  2 , David A Wolk  12 , Nalaka Gooneratne  3
Affiliations

Predictors of Adherence to Continuous Positive Airway Pressure in Older Adults With Apnea and Amnestic Mild Cognitive Impairment

Kathy C Richards et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: Almost 60% of adults with amnestic mild cognitive impairment (aMCI) have obstructive sleep apnea (OSA). Treatment with continuous positive airway pressure (CPAP) may delay cognitive decline, but CPAP adherence is often suboptimal. In this study, we report predictors of CPAP adherence in older adults with aMCI who have increased odds of progressing to dementia, particularly due to Alzheimer's disease.

Methods: The data are from Memories 2, "Changing the Trajectory of Mild Cognitive Impairment with CPAP Treatment of Obstructive Sleep Apnea." Participants had moderate to severe OSA, were CPAP naïve, and received a telehealth CPAP adherence intervention. Linear and logistic regression models examined predictors.

Results: The 174 participants (mean age 67.08 years, 80 female, 38 Black persons) had a mean apnea-hypopnea index of 34.78, and 73.6% were adherent, defined as an average of ≥4 hours of CPAP use per night. Only 18 (47.4%) Black persons were CPAP adherent. In linear models, White race, moderate OSA, and participation in the tailored CPAP adherence intervention were significantly associated with higher CPAP use at 3 months. In logistic models, White persons had 9.94 times the odds of adhering to CPAP compared to Black persons. Age, sex, ethnicity, education, body mass index, nighttime sleep duration, daytime sleepiness, and cognitive status were not significant predictors.

Conclusions: Older patients with aMCI have high CPAP adherence, suggesting that age and cognitive impairment should not be a barrier to prescribing CPAP. Research is needed to improve adherence in Black patients, perhaps through culturally tailored interventions.

Keywords: Motivational enhancement; Obstructive sleep apnea; Race; Tailored.

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Conflict of interest statement

K.C. R. has received Horizant and placebo from Arbor Pharmaceuticals, and consulting fees from Merck and Woolsey Pharmaceuticals, Inc. D.A.W. has received grant support from Biogen and Merck, serves on the Data Safety Monitoring Board for Functional Neuromodulation, and has received consulting fees from Eli Lilly, GE Healthcare, and Qynapse.

Figures

Figure 1.
Figure 1.
Consort diagram for Memories 2 Apnea Group. AHI = apnea–hypopnea index, aMCI = amnestic mild cognitive impairment, CAI = CPAP adherence intervention, CPAP = continuous positive airway pressure, GDS = geriatric depression scale, LTF = lost to follow-up, OSA = obstructive sleep apnea, PCP = primary care provider, WD = voluntary withdrawal.
See this image and copyright information in PMC

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