Factors Affecting CPAP Acceptance in Elderly Patients With Obstructive Sleep Apnea in Taiwan

Abstract

BACKGROUND: The prevalence of obstructive sleep apnea (OSA) increases with age. Treatment often includes CPAP. CPAP adherence is correlated with disease severity and symptoms. We hypothesized that CPAP acceptance rates in elderly patients with OSA would be lower than in younger patients with OSA, and examined factors associated with CPAP acceptance. METHODS: We reviewed the charts of 315 subjects with OSA (apnea-hypopnea index > 5 events/h) who were treated at our hospital from 2008 to 2011 with CPAP therapy. All underwent CPAP titration testing before CPAP prescription. Subjects were grouped by age: young (25-40 y, n ‫؍‬ 35), middle-age (41-65 y, n ‫؍‬ 169), and elderly (> 65 y, n ‫؍‬ 111). Demographic variables, excessive daytime sleepiness, overnight polysomnography study variables, CPAP acceptance, and CPAP adherence were compared. Regression analysis was performed to identify factors associated with acceptance. RESULTS: The elderly subjects had less excessive daytime sleepiness and less pronounced alterations in overnight polysomnography variables than the subjects in the other groups, but had more cardiovascular comorbidities. The CPAP acceptance rate (overall 125/315, 39.7%) was significantly lower in the elderly group, compared with the younger group (31.5% vs 60%, P ‫؍‬ .01). CPAP acceptance was associated with fewer comorbidities, higher excessive daytime sleepiness, and higher apnea-hypopnea index, but not age. CPAP adherence was not associated with age. CONCLUSIONS: CPAP acceptance is low in elderly patients in Taiwan. CPAP acceptance, instead of CPAP adherence, is the critical issue with elderly patients with OSA.

Management and Risk Reduction of Rheumatoid Arthritis in Individuals with Obstructive Sleep Apnea: A Nationwide Population-Based Study in Taiwan

“…Consequently, it is unclear whether patients with OSA who received long-term CPAP had lower risk of RA compared to patients with similar severity of OSA but with short-term CPAP use. Yang et al 48 had reported that the rate of CPAP adherence in Taiwan is 64%, which is similar to rates reported in previous studies. [49][50][51] However, it is still possible that some patients receiving CPAP treatment were nonadherent and this would suggest that we underestimated the benefits of CPAP.…”

Acceptance and Adherence to Continuous Positive Airway Pressure Therapy in patients with Obstructive Sleep Apnea (OSA) in a Southeast Asian privately funded healthcare system

“…Other studies suggested a greater concern with CPAP acceptance. One study on a Chinese population reported one-third of OSA patients who declined CPAP therapy after CPAP titration 10 while another study performed in Taiwan reported an even lower CPAP acceptance rate of 39.7%, particularly among the elderly 11 . Predictors of CPAP adherence which are largely based on studies conducted in the Western population may be broadly classified into factors including disease and patient characteristics, treatment titration procedures, device factors, psychological and social factors 12 .…”

Beneficial Effects of Long-Term CPAP Treatment on Sleep Quality and Blood Pressure in Adherent Subjects With Obstructive Sleep Apnea

“…This was also documented in our previous study. 15 This interesting result showing that subjects in the low-adherence group were younger reveals that savvy and health concern seem more common in older subjects. We claim that this is also possibly related to socioeconomic status.…”