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Nasal versus oronasal mask in patients under auto-adjusting continuous positive airway pressure titration: a real-life study

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Abstract

Purpose

Mask type (nasal versus oronasal) can affect the optimal pressure required to correct the apnea/hypopnea index (AHI) in obstructive sleep apnea (OSA) subjects treated with CPAP. Our objective was to evaluate if mask type influenced CPAP titration outcomes in OSA patients.

Methods

A retrospective study of individuals with a baseline AHI ≥ 15.0/h, who received an auto-adjusting CPAP titrating device (S9 AutoSet ResMed®) in a sleep-lab setting. The mask type oronasal (OM) or nasal (NM) was always selected by the patients. Optimal pressure requirements, leak, and residual AHI were compared based on mask type.

Results

Overall, 436 patients were included: 283 with NM (64.9%) and 153 with OM (35.1%). At baseline, NM and OM cohorts had similar AHI (p = 0.160). Patients allocated to the OM cohort had a higher 95th percentile pressure, a higher 95th percentile leak, and a higher residual AHI than those with a NM: pressure requirement: 12.9 cm H2O (IQR: 10.6–15.0) versus 10.7 cm H2O (IQR: 9.2–12.3); leak: 21.6 L/min (IQR: 9.6–37.2) versus 9.6 L/min (IQR: 3.6–19.2); and residual AHI: 4.9/h (IQR: 2.4–10.2) versus 2.2/h (IQR: 1.0–4.4), respectively (p < 0.001 for all).

Conclusions

CPAP mask type based on individual preferences exerts profound effects on optimal CPAP pressures and efficacy. Patients titrated with OM showed higher pressure requirements, had higher a leak, and higher residual AHI when compared to NM, which may adversely impact treatment adherence and other health outcomes.

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References

  1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2003) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014

    Article  Google Scholar 

  2. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 3:310–318

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K et al (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 13:479–504

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sánchez-de-la-Torre M, Campos-Rodriguez F, Barbé F (2013) Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med 1:61–72

    Article  PubMed  Google Scholar 

  5. Peled N, Kassirer M, Shitrit D, Kogan Y, Shlomi D, Berliner AS et al (2007) The association of OSA with insulin resistance, inflammation and metabolic syndrome. Respir Med 101:1696–1701

    Article  PubMed  Google Scholar 

  6. Boland LL, Shahar E, Iber C, Knopman DS, Kuo TF, Nieto FJ et al (2002) Measures of cognitive function in persons with varying degrees of sleep-disordered breathing: the Sleep Heart Health Study. J Sleep Res 11:265–272

    Article  PubMed  Google Scholar 

  7. Mulgrew AT, Nasvadi G, Butt A, Cheema R, Fox N, Fleetham JA et al (2008) Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea. Thorax 63:536–541

    Article  CAS  PubMed  Google Scholar 

  8. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG (2019) Treatment of adult obstructive sleep apnea with positive airway pressure: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 15:335–343

    Article  PubMed  PubMed Central  Google Scholar 

  9. Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ (2006) Continuous positive airway pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001106.pub3

    Article  PubMed  Google Scholar 

  10. Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R et al (2011) CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med 365:2277–2286

    Article  CAS  PubMed  Google Scholar 

  11. Kohler M, Smith D, Tippett V, Stradling JR (2010) Predictors of long-term compliance with continuous positive airway pressure. Thorax 65:829–832

    Article  PubMed  Google Scholar 

  12. Gao W, Jin Y, Wang Y, Sun M, Chen B, Zhou N et al (2012) Is automatic CPAP titration as effective as manual CPAP titration in OSAHS patients? A meta-analysis. Sleep Breath 16:329–340

    Article  PubMed  Google Scholar 

  13. Morgenthaler TI, Aurora RN, Brown T, Zak R, Alessi C, Boehlecke B et al (2008) Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine Report. Sleep 31:141–147

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chai CL, Pathinathan A, Smith B (2006) Continuous positive airway pressure delivery interfaces for obstructive sleep apnoea. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005308.pub2

    Article  PubMed  Google Scholar 

  15. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE (2011) A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev 15:343–356

    Article  PubMed  PubMed Central  Google Scholar 

  16. Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B et al (2013) Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS ONE 8:e64382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Schwab RJ, Badr SM, Epstein LJ, Gay PC, Gozal D, Kohler M et al (2013) An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med 188:613–620

    Article  PubMed  PubMed Central  Google Scholar 

  18. Andrade RGS, Viana FM, Nascimento JA, Drager LF, Moffa A, Brunoni AR et al (2018) Nasal vs oronasal CPAP for OSA treatment: a meta-analysis. Chest 153:665–674

    Article  PubMed  Google Scholar 

  19. Madeiro F, Andrade RGS, Piccin VS, Pinheiro GDL, Moriya HT, Genta PR et al (2019) Transmission of oral pressure compromises oronasal CPAP efficacy in the treatment of OSA. Chest 156:1187–1194

    Article  PubMed  Google Scholar 

  20. Andrade RG, Piccin VS, Nascimento JA, Viana FM, Genta PR, Lorenzi-Filho G (2014) Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea. J Bras Pneumol 40:658–668

    Article  PubMed  PubMed Central  Google Scholar 

  21. Massie CA, Hart RW (2003) Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest 123:1112–1118

    Article  PubMed  Google Scholar 

  22. Beecroft J, Zanon S, Lukic D, Hanly P (2003) Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest 124:2200–2208

    Article  PubMed  Google Scholar 

  23. Goh KJ, Soh RY, Leow LC, Toh ST, Song PR, Hao Y et al (2019) Choosing the right mask for your Asian patient with sleep apnoea: a randomized, crossover trial of CPAP interfaces. Respirology 24:278–285

    Article  PubMed  Google Scholar 

  24. Rowland S, Aiyappan V, Hennessy C, Catcheside P, Chai-Coetzer CL, McEvoy RD et al (2018) Comparing the efficacy, mask leak, patient adherence, and patient preference of three different CPAP interfaces to treat moderate-severe obstructive sleep apnea. J Clin Sleep Med 14:101–108

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ebben MR, Narizhnaya M, Segal AZ, Barone D, Krieger AC (2014) A randomised controlled trial on the effect of mask choice on residual respiratory events with continuous positive airway pressure treatment. Sleep Med 15:619–624

    Article  PubMed  Google Scholar 

  26. Ebben MR, Oyegbile T, Pollak CP (2012) The efficacy of three different mask styles on PAP titration night. Sleep Med 13:645–649

    Article  PubMed  Google Scholar 

  27. Schorr F, Genta PR, Gregório MG, Danzi-Soares NJ, Lorenzi-Filho G (2012) Continuous positive airway pressure delivered by oronasal mask may not be effective for obstructive sleep apnoea. Eur Respir J 40:503–505

    Article  PubMed  Google Scholar 

  28. Ng JR, Aiyappan V, Mercer J, Catcheside PG, Chai-Coetzer CL, McEvoy RD et al (2016) Choosing an oronasal mask to deliver continuous positive airway pressure may cause more upper airway obstruction or lead to higher continuous positive airway pressure requirements than a nasal mask in some patients: a case series. J Clin Sleep Med 12:1227–1232

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bakker JP, Neill AM, Campbell AJ (2012) Nasal versus oronasal continuous positive airway pressure masks for obstructive sleep apnea: a pilot investigation of pressure requirement, residual disease, and leak. Sleep Breath 16:709–716

    Article  PubMed  Google Scholar 

  30. Bettinzoli M, Taranto-Montemurro L, Messineo L, Corda L, Redolfi S, Ferliga M et al (2014) Oronasal masks require higher levels of positive airway pressure than nasal masks to treat obstructive sleep apnea. Sleep Breath 18:845–849

    Article  PubMed  Google Scholar 

  31. Shirlaw T, Duce B, Milosavljevic J, Hanssen K, Hukins C (2019) A randomised crossover trial comparing nasal masks with oronasal masks: No differences in therapeutic pressures or residual apnea-hypopnea indices. J Sleep Res 28:e12760

    Article  PubMed  Google Scholar 

  32. Teo M, Amis T, Lee S, Falland K, Lambert S, Wheatley J (2011) Equivalence of nasal and oronasal masks during initial CPAP titration for obstructive sleep apnea syndrome. Sleep 34:951–955

    Article  PubMed  PubMed Central  Google Scholar 

  33. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    Article  CAS  PubMed  Google Scholar 

  34. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med 8:597–619

    Article  PubMed  PubMed Central  Google Scholar 

  35. Liang Y, Kimball WR, Kacmarek RM, Zapol WM, Jiang Y (2008) Nasal ventilation is more effective than combined oral-nasal ventilation during induction of general anesthesia in adults subjects. Anesthesiology 108:998–1003

    Article  PubMed  Google Scholar 

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Correspondence to Ricardo L. M. Duarte.

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The authors declare that they have no conflict of interest.

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The study was approved by Ethics Committee of the Federal University of Rio de Janeiro (number: 666.608).

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This was a retrospective data analysis study and it did not need informed consent.

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Duarte, R.L.M., Mendes, B.A., Oliveira-e-Sá, T.S. et al. Nasal versus oronasal mask in patients under auto-adjusting continuous positive airway pressure titration: a real-life study. Eur Arch Otorhinolaryngol 277, 3507–3512 (2020). https://doi.org/10.1007/s00405-020-06242-x

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