PT  - JOURNAL ARTICLE
AU  - Stephanie Hobbins
AU  - Amina Mohamed
AU  - Michael Lang
AU  - Nazim Nathani
TI  - A case series of CPAP therapy – Who declines treatment?
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - P2289
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/P2289.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/P2289.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - IntroductionOur department initiates approx. 600 patients on CPAP annually through 3 sleep clinics and historically has an acceptance rate of 75%. We wanted to identify common patient factors in the withdrawal group with a view to improving acceptance.MethodPatient characteristics and polysomnography data of individuals attending 1 sleep clinic over a 2year period who withdrew CPAP therapy were retrospectively reviewed.Results48 patients were identified with mean BMI 34.25 and AHI 25.19. 67% of all patients were referred with predominantly snoring symptoms. Of the CPAP failures, 14 declined trial with no clear reason. 2 had surgical intervention and 5 did not start therapy. Of the patients who withdrew after initiation (n=27), 5 also had significant nocturnal hypoxia and hypoventilation.View this table:Polysomnography data for patients failing CPAP therapyCommon reasons for withdrawing were intolerance due to anxiety, claustrophobia or cough.ConclusionThis review does not reveal specific characteristics although patients with snoring rather than somnolence predominant OSA may be less motivated to accept treatment. CPAP failures tended to have lower Epworth scores and so may underestimate the significance of their condition.Patients with OHS are a distinct group who we need to persevere with bilevel ventilation with or without oxygen. Options for OSA patients include inpatient retrial, bilevel ventilation or non-benzodiazepine sedation with reintroduction of CPAP. Whether these measures would be successful or cost effective awaits evaluation.