Domiciliary non-invasive ventilation in patients 65 years or older. A case series study

Aim: To describe the clinic characteristics of patients with domiciliary non-invasive ventilation (DNIV) in 65 years or older at BIPAP onset in a Sleep Disorders Unit (SDU). Methods: Transversal descriptive study of a case series between February 2000 and June 2010. Inclusion criteria: 1. Age ≥ 65 years at BIPAP onset. 2. Polisomnography or Polygraphy available prior BIPAP prescription. Definitions: SAHS was considered when AHI ≥ 10 and severe SAHS if AHI ≥ 30; Obesity Hypoventilation Syndrome (OHS) was defined as a BMI ≥ 30 and PaCO 2 ≥ 45 mmHg at daytime; Excessive Daytime Somnolence (EDS) if Epworth Somnolence Scale (ESS) score ≥ 12. Results: 82 out of 153 patients with DNIV met the inclusion criteria. 53 (65%) women and 29 (35%) men. Values expressed by mean ± standard deviation were: Age when starting treatment: 72±4; BMI: 37.54±6.9; neck circumference: 41.9±3.5 cm; ESS: 10.7±5.3; EDS: 37 (41%) patients; AHI: 31.7±22. SAHS was diagnosed in 75 (91.5%) patients and was severe in 36 (44%). BIPAP prescription was due to: OHS in 48 (59%) patients, combined pathology in 20 (24%) patients, neuromuscular disease in 9 (11%) and COPD in 5 (6%) patients. BIPAP was initially prescribed in 38 (46%) patients, most of them with neuromuscular disease and combined pathology (p 0.017). Conversely, in 44 (54%) patients, most of them with OHS or COPD (p 0,017), it was prescribed CPAP at first and changed to BIPAP. Conclusions: Half of the patients with DNIV were ≥ 65 years old at the beginning of the treatment. All patients were obese and most of them, women. The most common cause of prescribing BIPAP was neuromuscular disease and the most common cause of change from CPAP to BIPAP was OHS.