Gerontological effects on arousal frequency, autonomic balance, and slow-wave sleep during pressure adjustments of CPAP in OSA patients
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Journal Article
Abstract
Objective: Continuous positive airway pressure (CPAP) therapy is recognized as first-line treatment for obstructive sleep apnea (OSA), but tolerance to pressure adjustments may differ with age. In this study, we examined age-related differences in physiological and neurophysiological responses following CPAP pressure adjustment.
Methods: In this retrospective study, we analyzed baseline polysomnography (PSG) and CPAP titration data from 40 individuals, including 20 younger (< 65 years) and 20 older adults (≥ 65 years) matched at the group level. Time-specific analyses were conducted using 10-min windows following pressure adjustments. Group comparisons across predefined pressure categories of CPAP (4– 5, 6– 7, and ≥ 8 cmH2O) and age groups were performed using one-way analysis of variance (ANOVA) or Kruskal–Wallis tests, as appropriate, with post-hoc analyses. Single and multiple linear regression analyses were conducted to assess associations between CPAP pressure categories and physiological responses, using the 4– 5 cmH2O group as the reference and adjusting for prior pressure change history and sleep-stage distribution.
Results: Both age groups demonstrated improvements in sleep architecture and sleep disorder indices during CPAP titration. Among older individuals, analyses of 10-min periods following pressure adjustments showed a higher arousal frequency, increased elevated standard deviation (SD) of normal-to-normal (NN) intervals (SDNN) and low-frequency (LF)/high-frequency (HF) ratios, and reduced slow-wave peak-to-peak amplitudes and slopes compared to younger counterparts. Regression analyses further indicated associations between pressure categories, HRV features, and slow-wave characteristics in the elderly group.
Conclusion: These findings highlight potential age-related differences in short-term responses to pressure adjustments for CPAP. Future prospective studies are needed to validate and enhance the generalizability and robustness of these findings.
Methods: In this retrospective study, we analyzed baseline polysomnography (PSG) and CPAP titration data from 40 individuals, including 20 younger (< 65 years) and 20 older adults (≥ 65 years) matched at the group level. Time-specific analyses were conducted using 10-min windows following pressure adjustments. Group comparisons across predefined pressure categories of CPAP (4– 5, 6– 7, and ≥ 8 cmH2O) and age groups were performed using one-way analysis of variance (ANOVA) or Kruskal–Wallis tests, as appropriate, with post-hoc analyses. Single and multiple linear regression analyses were conducted to assess associations between CPAP pressure categories and physiological responses, using the 4– 5 cmH2O group as the reference and adjusting for prior pressure change history and sleep-stage distribution.
Results: Both age groups demonstrated improvements in sleep architecture and sleep disorder indices during CPAP titration. Among older individuals, analyses of 10-min periods following pressure adjustments showed a higher arousal frequency, increased elevated standard deviation (SD) of normal-to-normal (NN) intervals (SDNN) and low-frequency (LF)/high-frequency (HF) ratios, and reduced slow-wave peak-to-peak amplitudes and slopes compared to younger counterparts. Regression analyses further indicated associations between pressure categories, HRV features, and slow-wave characteristics in the elderly group.
Conclusion: These findings highlight potential age-related differences in short-term responses to pressure adjustments for CPAP. Future prospective studies are needed to validate and enhance the generalizability and robustness of these findings.
Date Issued
2026-03-11
Date Acceptance
2026-02-18
Citation
Nature and Science of Sleep, 2026, 18
ISSN
1179-1608
Publisher
Dove Medical Press
Journal / Book Title
Nature and Science of Sleep
Volume
18
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Published
Article Number
578482
Date Publish Online
2026-03-11