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Hypersensitivity pneumonitis is a potentially fatal immunological lung disease caused by occupational or environmental exposure to specific antigens. Here, we report on an obstructive sleep apnea patient whose hypersensitivity pneumonitis was aggravated because of the use of unclean continuous positive airway pressure equipment. This report shows that careful history taking is important when diagnosing hypersensitivity pneumonitis. Sleep specialists should be aware of the risks related to unclean continuous positive airway pressure equipment use, and obstructive sleep apnea patients should be instructed and monitored in the regular cleaning of their equipment., (© 2017 The Authors. The Clinical Respiratory Journal Published by John Wiley & Sons Ltd.)

Background: Obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular diseases. Although CPAP is the first treatment choice for moderate-to-severe OSA, acceptance of and adherence to CPAP remain problematic. High CPAP adherence is generally defined as ≥4 h of use/night for ≥70% of the nights monitored. We investigated the long-term beneficial effects of CPAP on sleep quality and blood pressure in subjects with moderate-to-severe OSA according to high or low CPAP adherence., Methods: We retrospectively analyzed 121 subjects with moderate-to-severe OSA from August 2008 to July 2012. These subjects were divided into 3 groups: (1) no CPAP treatment (n = 29), (2) low CPAP adherence (n = 28), and (3) high CPAP adherence (n = 64). All subjects were followed up for at least 1 y. The 3 groups were compared regarding anthropometric and polysomnographic variables, presence of cardiovascular comorbidities, and blood pressure at baseline and at the last follow-up., Results: The no-treatment group showed significant increases in oxygen desaturation index and blood pressure. The high-adherence group showed significant improvement in daytime sleepiness, apnea-hypopnea index (AHI), oxygen desaturation index, and blood pressure. Although the AHI was also significantly decreased after CPAP treatment in the low-adherence group, blood pressure remained unchanged., Conclusions: CPAP treatment had beneficial effects on both sleep quality and blood pressure only in subjects with OSA and high CPAP adherence who used CPAP for ≥4 h/night for ≥70% of nights monitored. Subjects with low CPAP adherence received beneficial effects on AHI, but not blood pressure., (Copyright © 2015 by Daedalus Enterprises.)

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.

In our previous study, we observed younger OSAS patients had higher CPAP acceptance but similar compliance as older OSAS patients, suggesting gender factor might play an important role on CPAP acceptance. Hence, we aimed to evaluate the influences of both gender and age on CPAP acceptance and compliance in Taiwanese OSAS patients. This retrospective study included 371 subjects which were subdivided by gender and age (younger: age < 55 years, and older: age ≥ 55 years) ( n = 24 for younger women, n = 67 for older women, n = 131 for younger men; and n = 149 for older men). Anthropometric parameters, blood pressures, Epworth sleepiness scale, polysomnography variables, CPAP acceptance, and CPAP compliance were collected and compared. Univariate analysis evaluated the influence of different variables on CPAP acceptance. Due to the presence of multicollinearity for N3 sleep and AHI, as well as N3 sleep and DI, multivariate logistic regression models were conducted using three different models with N3 sleep, AHI, and DI included separately. Univariate analysis found women had less CPAP acceptance than men. Multivariate logistic regression analysis indicated younger women had lower CPAP acceptance, but in contrast younger men had higher CPAP acceptance. No difference was observed among the four subgroups for long-term CPAP compliance. In conclusion, our findings suggest that both age and gender impact CPAP acceptance for treating OSAS in Taiwan, with women having lower CPAP acceptance than men regardless of age. No apparent influence of age and gender on CPAP compliance was observed. [ABSTRACT FROM AUTHOR]