OSA in the aging population: Diagnostic and therapeutic considerations

The extremely high prevalence of obstructive sleep apnea (OSA) in the elderly population approaches 50 % and is even higher among individuals older than 80 years, posing substantial challenges in defining an appropriate risk-benefit balance for OSA treatment in this age group. A major barrier to the formulation of coherent, evidence-based recommendations lies in the marked limitations of the available evidence, which is often derived from observational or post hoc analyses, affected by substantial heterogeneity, or based on small samples that lack adequate statistical power to detect clinically meaningful outcomes. Moreover, older adults-particularly the very old and those with multimorbidity or frailty-are systematically underrepresented in randomized controlled trials, further limiting the generalizability of existing findings. In this review, we synthesize the scarce and methodologically heterogeneous evidence on the impact of OSA in older adults, highlight conflicting results supporting either treatment or non-treatment in this population, and delineate the key unresolved clinical and research questions that must be addressed before robust consensus guidelines and informed healthcare policies can be developed.