Compliance with CPAP therapy in older men with obstructive sleep apnea

OBJECTIVES: Factors specifically affecting compliance with continuous posit ive airway pressure (CPAP) in older patients with obstructive sleep apnea ( OSA) have not been described. The purpose of this study is to determine whi ch factors are associated with compliance and noncompliance in older patien ts, a growing segment of the population. DESIGN: A retrospective chart review of older male patients prescribed CPAP therapy for OSA over an 8-year period. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: All patients age 65 and older for whom CPAP therapy had been prescribed for treatment of OSA in the past 8 years. MEASUREMENTS: Records of all older male patients prescribed CPAP therapy fo r OSA over the last 8 years were reviewed. Compliance was defined by time-c ounter readings averaging 5 or more hours of machine run-time per night. RESULTS: Of 33 older male patients with OSA studied, 20 were found to be co mpliant and 13 noncompliant with nasal CPAP therapy. The mean age (+/- SEM) at the time of diagnosis of OSA in the compliant group was 68 (+/-1) years , whereas that of the noncompliant group was 72 (+/-1) years (P < .05). Of the compliant patients, 95% attended a CPAP patient education and support g roup, whereas only 54% of noncompliant patients attended (P = .006). Resolu tion of initial symptoms of OSA with CPAP therapy was significantly associa ted with compliance. Symptom resolution occurred in 90% of compliant patien ts and in only 18% of noncompliant patients (P < .0002). Factors that were significantly associated with noncompliance with CPAP were cigarette smokin g, nocturia, and benign prostatic hypertrophy (BPH). Of noncompliant patien ts, 82% complained of nocturia, whereas only 33% of compliant patients comp lained of nocturia (P = .02). BPH was diagnosed in 62% of noncompliant pati ents and in only 15% of compliant patients (P = .004). Diuretic use was mor e common in the compliant group and, therefore, was not a cause of increase d nocturia in noncompliant patients. CONCLUSION: In older male patients with OSA, compliance with CPAP therapy i s associated with attendance at a patient CPAP education and support group. Resolution of symptoms with therapy also appears to be associated with enh anced compliance. In addition, we found an association between nocturia and the existence of BPH in older men with OSA who are not compliant with nasa l CPAP. Larger observational studies should be performed to confirm these f indings, and, if so confirmed, then further studies to determine whether tr eatment of BPH in older men with OSA improves compliance with CPAP.