Researchers from Marshall University, the University of Washington, IRCCS Istituto Auxologico Italiano and the University of Milano-Bicocca in Italy, University and Polytechnic La Fe Hospital in Spain have published a comprehensive review highlighting the urgent need for more individualized, age-adapted approaches to diagnosing and treating obstructive sleep apnea (OSA) in older adults.
The article, published in Sleep Medicine Reviews , examines the rapidly growing prevalence of OSA in aging populations and outlines the clinical challenges of balancing potential risks and benefits of treatment in adults age 65 and older, particularly those older than 80 and those living with frailty or multiple chronic conditions. OSA affects nearly half of older adults and becomes even more common in the very elderly, yet this population remains significantly underrepresented in randomized clinical trials. As a result, many diagnostic thresholds and treatment recommendations — including the use of continuous positive airway pressure (CPAP) therapy — are largely derived from studies of younger or middle-aged populations.
The review synthesizes available evidence showing that aging is associated with distinct physiological changes in upper airway function, ventilatory control and sleep architecture that may alter how OSA develops and responds to therapy. Older adults often present without classic symptoms such as excessive daytime sleepiness, instead experiencing fatigue, insomnia, cognitive changes, falls or mood disturbances. The authors also highlight the close relationship between OSA and frailty, noting that intermittent hypoxia, inflammation and hormonal dysregulation may contribute to declining physical and cognitive reserve. While CPAP remains the standard treatment for moderate-to-severe OSA, evidence suggests that benefits may be attenuated in patients over 80, and adherence declines significantly with advancing age.
The review was authored by Martino F. Pengo, M.D., Ph.D., of IRCCS Istituto Auxologico Italiano and the University of Milano-Bicocca in Milan, Italy; Miguel Ángel Martínez-García, M.D., Ph.D., of University and Polytechnic La Fe Hospital in Valencia, Spain; Michael V. Vitiello, Ph.D., of the University of Washington in Seattle; and David Gozal, M.D., MBA, Ph.D. (Hon) of the Joan C. Edwards School of Medicine at Marshall University in Huntington, West Virginia. The authors emphasize that treatment decisions in older adults should prioritize symptom burden, functional status, frailty and patient-centered goals rather than relying solely on apnea–hypopnea index thresholds, and they call for well-designed clinical trials specifically enrolling older and frail adults to guide future practice and policy as populations continue to age worldwide.
To view the article in its entirety, please visit doi.org/10.1016/j.smrv.2026.102247 .
About Marshall University's Joan C. Edwards School of Medicine
The Marshall University Joan C. Edwards School of Medicine is a community-based medical school established in 1977 known for its hands-on approach that produces skilled physician and physician assistant graduates in all specialties of medicine with a special focus on rural health. Through its centers of wellness, research initiatives and community outreach programs, the school actively advances innovative health care solutions while addressing the unique needs of Appalachian communities.
