Barriers of continuous positive airway pressure machine purchasing in older adults with obstructive sleep apnea

Obstructive sleep apnea (OSA) is very prevalent in older adults and causes several cardiovascular diseases as well as neurological conditions such as cognitive impairment. These consequences of OSA can be prevented by treatment with a continuous positive airway pressure machine (CPAP). Even though CPAP is effective, not all older adults with OSA purchased it for personal use. This study aimed to evaluate why older adults with OSA denied purchasing CPAP by using a qualitative study. This was a qualitative study among older adults diagnosed with OSA, participated in the CPAP titration trial for at least three nights, and denied purchasing the CPAP. An in-depth interview was performed in eligible patients until data saturation to find factors or themes whether older adults did not purchase CPAP. There were 15 older adults with OSA who did not purchase CPAP and participated in the study. The average (SD) age of all patients was 67.73 (5.84) years with a proportion of male patients of 46.67% (7 patients). There were three themes on why the older adults with OSA did not purchase CPAP including financial constraints, lack of family financial support, and OSA perspectives. Older adults with OSA who did not purchase CPAP did not want to treat OSA, though they already had several consequences of OSA. They believed that they had OSA for a long time and wanted to live with OSA resulting in denying CPAP therapy. Conservative treatment with other options was justified for them. Additionally, they were not afraid of death and expected to die peacefully. Older adults who did not purchase CPAP for their personal use may be mainly due to unaffordability to CPAP by any reason. Universal health insurance coverage for older adults with OSA may enhance CPAP acceptability.