The association of age with continuous positive airway pressure ventilation acceptance in an outpatient cohort of patients with obstructive sleep apnea

Study Objectives: This study examined the association between age and continuous positive airway pressure (CPAP) acceptance in a consecutive series of patients with obstructive sleep apnea being managed in a physician-led outpatient CPAP acclimatization program in Canberra, Australia. Methods: We performed a retrospective consecutive case series analysis of registry data collected from patients attending the Canberra Hospital PAP Acclimatization Clinic between 2011 and 2019. Data on patient demographics, diagnostic polysomnography results, CPAP device download parameters during acclimatization, and overall CPAP acceptance at the end of acclimatization were extracted from the Clinic Registry. Analysis of variance and chi-square were used to assess for associations between patient age, CPAP acceptance, and other clinical characteristics. Univariate and stepwise multiple logistic regression was used to identify predictors of CPAP acceptance. Results: We found that 1,075 consecutive CPAP trials among 1,043 patients were eligible for inclusion. CPAP acceptance was lower in those aged > 75 years compared with those aged ≤ 75 years (odds ratio: 0.57; 95% confidence interval, 0.36–0.92; P = .02). Patients aged > 75 years had lower body mass index, had higher initial and final visit 95th percentile mask leak, and were less likely to be CPAP naïve. Using univariate regression, younger age, severe obstructive sleep apnea, obesity, shorter trial duration, more clinic visits, higher initial visit CPAP usage, and lower final visit mask leak were predictors of CPAP acceptance. In a multiple logistic regression model, younger age, severe obstructive sleep apnea, shorter trial duration, more clinic visits, higher first visit usage, and lower final visit leak predicted acceptance. Conclusions: Older age is associated with lower CPAP acceptance. The factors contributing to this association are unclear and require further investigation.