Individualized Treatment Approaches for Obstructive Sleep Apnea in Older Adults: Beyond Continuous Positive Airway Pressure.

Abstract

With an aging population and greater prevalence of metabolic disorders, obstructive sleep apnea (OSA) is increasingly observed in older patients. OSA in older adults often occurs in the setting of various comorbidities, such as cognitive, cardiac, and metabolic dysfunction, placing these patients at greater risk. Continuous positive airway pressure (CPAP) is the first-line treatment for OSA in most patients, but adherence with CPAP decreases with increasing age. Current literature on considerations and efficacy of treatment modalities for OSA in older patients is limited. This narrative review summarizes current evidence on CPAP and non-CPAP therapies of OSA in older adults with particular attention to age-specific differences in clinical presentation, diagnostic challenges, and implications for quality of life. Relevant guidelines, clinical studies, and systematic reviews selected from the PubMed and Cochrane databases through April 2026 were summarized and categorized based on type of therapy. Some non-CPAP alternatives appear promising or effective in selected adults for improving metrics of sleep, quality of life, and mitigating comorbidities, but for geriatric-specific comparative evidence remains limited, indirect, observational, or derived from adults substantially younger than the target population. Lifestyle modifications, positional therapy, and oral appliances may yield benefits in older patients comparable to those seen in their younger counterparts, but age-stratified studies are limited. While pharmacotherapy is an area of emerging study, GLP-1 RAs show significant early potential with multifaceted benefits, although supporting studies have been primarily conducted in middle-aged adults. Hypoglossal nerve stimulation has emerged as a prominent OSA treatment alternative with improved adherence compared to CPAP in in small elderly-specific studies. OSA management in older patients is highly nuanced with multifactorial consideration of polypharmacy, comorbidities, and patient preferences to optimize patient outcomes. Larger-scale, prospective studies specific to older patients are warranted to assess treatment efficacy, adherence, and adverse effects in this population.