Aging reduces the impact of CPAP on sleepiness in OSA patients

<bold>Introduction or background:</bold> Limited data suggest a stronger association between AHI and sleepiness and a larger impact of CPAP on symptoms in younger patients. <bold>Aims and objectives:</bold> We aimed to evaluate the impact of CPAP on sleepiness according to age in a large prospective clinical cohort of patients adherent to CPAP treatment. <bold>Methods:</bold> Within the multicentre IRSR Pays de la Loire Sleep Cohort, we identified PAP adherent OSA patients (mean use >4h/days at 6 months follow-up). A multivariate regression model was used to assess predictors of a change in the Epworth Sleepiness Scale (ESS) score (difference between score at inclusion and at 6-month follow-up). <bold>Results:</bold> In response to CPAP treatment, the ESS score significantly decreased compared to baseline by 3.9 (95% CI, 3.7,4.1) in the 3298 included patients. In the univariate analysis, baseline age (p<0.001), IMC (p<0.002) and AHI (p<0.001), ESS at baseline (p<0.001) and sexe (p<0.001) were associated with changes in ESS score. Interestingly, in the multivariate analysis, the association between age with changes in ESS score remained significant after adjustments on BMI, sexe and even after adjustment on baseline AHI (Coef. [95% CI] -0.06 [−0.073, -0.045], p<0.001). <bold>Conclusions:</bold> The age-related reduction in the impact of CPAP on sleepiness may have clinical implications for the diagnosis and treatment of SDB in older people since sleepiness is often used as a therapeutic marker. In contrast, a lower AHI cut-off could be considered for CPAP initiation for symptomatic younger patients. Ongoing analysis will determine if similar association is observed for the impact of CPAP on quality of life (SF36).