0685 A Motivational Enhancement Intervention Improves CPAP Use in Older Adults with Mild Cognitive Impairment: A One-Year Trajectory

Abstract Introduction Approximately one-third of adults with obstructive sleep apnea (OSA) exhibit comorbid cognitive impairment. Although continuous positive airway pressure (CPAP) therapy has the potential to slow cognitive deterioration, suboptimal adherence may diminish therapeutic dose and limit clinical benefit. The aim of this analysis was to describe the effects of a tailored motivational enhancement intervention on the 1-year trajectory of CPAP adherence in older adults with mild cognitive impairment (MCI), and to identify predictors of CPAP adherence in this population. Methods Data were drawn from Memories 2, a multisite trial evaluating whether treatment of moderate to severe OSA slows cognitive decline in adults aged 65-85 years with MCI. Participants received a tailored telehealth CPAP adherence intervention comprising: 1) OSA education, treatment expectations, and strategies to reduce barriers; 2) motivational enhancement to align CPAP use with participants’ health goals, strengthen self-efficacy, and address common CPAP challenges; and 3) social support by a study partner. Unadjusted and adjusted linear and logistic models examined predictors of 1-year CPAP use. Predictors included age, sex, race, ethnicity, education, apnea-hypopnea index (AHI), body mass index, daytime sleepiness, CPAP adherence intervention participation, and cognitive status. Results Among 172 participants with 1-year adherence data, 56% were male and 71% were White; mean age was 67.2 years, and mean AHI was 34.4 (SD 20.9). The proportion adherent (defined as mean nightly use of >= 4 hours) was 74% at 3 months, 72% at 6 months, 68% at 9 months, and 65% at 12 months. In adjusted models, White race (β = 2.12, SE = 0.54, p < 0.001), severe OSA (β = -0.77, SE = 0.39, p = 0.047) and intervention participation (β = 0.49, SE = 0.10, p < 0.001) were significantly associated with 1-year CPAP use. Conclusion A tailored telehealth motivational enhancement intervention produced high CPAP adherence across 12 months in older adults with MCI and moderate-severe OSA, outperforming adherence levels typically reported in general older adult populations. Additional strategies are needed to improve adherence in Black persons, who demonstrated lower use despite intervention exposure. Support (if any) R01AG054435