New trial to assess sleep apnoea treatment in elderly patients

(PhysOrg.com) -- A new trial to assess the most effective way of treating elderly people for a common sleep disorder is being launched at Imperial College London, thanks to a £1.5 million research grant from the NIHR’s Health Technology Assessment programme.

The trial will look at the treatment of obstructive sleep apnoea hypopnoea syndrome (OSAHS), the third most common respiratory disorder after asthma and chronic obstructive pulmonary disease. OSAHS affects 2-4% of middle-aged people and 20% of people aged over 65.

People with OSAHS temporarily stop breathing when they are asleep, because of a blockage in their upper airway, which wakes them up. As a result, they are often tired during the day. They can also develop high blood pressure and memory problems, because they wake up frequently and often have low levels of oxygen in their blood. The most commonly used treatment for OSAHS is called continuous positive airway pressure (CPAP) and it involves keeping the patient’s airway open by using a machine with a mask that pushes air into the mouth and nose.

In the new trial, the researchers will assess whether CPAP improves the quality of life of people with OSAHS over the age of 65. Previous studies have shown that CPAP is effective in middle-aged patients but until now there has been no research into the benefits of treatment in older patients.

The researchers believe that OSAHS may have a different physical effect on older people - for example, the condition may exaggerate age-related memory problems, because elderly people are less able to cope with the disturbed sleep patterns than middle-aged people.

The UK population is ageing and by 2030 the proportion of people over the age of 65 is estimated to increase from 16% to 23% of the population. 60% more people are predicted to need long-term care by 2040, which would increase the cost of the nation’s healthcare by approximately £4 billion per year. The new Imperial College London-led trial, called PREDICT, aims to discover whether treating elderly people with OSAHS is a cost effective way of improving their general health.

PREDICT is a randomised, single-blinded trial. It will involve over 270 patients - half will receive CPAP treatment and half will receive no treatment. The researchers hope to compare the patients’ tiredness, risk of heart problems and memory, or cognitive ability, to determine whether the treatment is effective. This is the first fully funded, multi-centre sleep disorder trial in the UK, involving six research centres, including the National Heart Lung Institute at Imperial, The University of Edinburgh, and the University of Oxford and patients at UK hospital trusts including the Royal Brompton & Harefield NHS Foundation Trust.

Dr Mary Morrell, from the National Heart and Lung Institute at Imperial College London, who is coordinating the trial with colleagues in Edinburgh and Oxford, said: “Although it’s not life-threatening, sleep apnoea can affect people’s health and have a big impact on their lives. For example, people with the condition are sleepy during the day and this means they often have to stop driving because they have an increased risk of accidents. Treating young and middle-aged patients with continuous positive airway pressure can improve their tiredness and increase energy levels but we have little evidence to show its effect on older patients.

“Our previous research has shown that older people with OSAHS have a smaller surge in blood pressure compared to younger people when they wake up from sleep. This may mean that older OSAHS patients are less likely to develop heart problems, but on the other hand we think the OSAHS is more likely to affect memory in elderly patients. This trial will help us discover whether treatment will help to improve these factors and therefore the quality of life,” added Dr Morrell.

Provided by Imperial College London