Skip to main content

Advertisement

SpringerLink
Log in

Choosing the right interface for positive airway pressure therapy in patients with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Review
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Positive airway pressure (PAP) is the standard and most effective treatment for obstructive sleep apnea (OSA). It provides a continuous stream of air under positive pressure through the nose, mouth, or both, which prevents collapse of the upper airway. This allows the patient to breathe freely during sleep. The success of PAP therapy depends largely on the selection of the proper interface (mask). The choice and application of the interface in patients with OSA is a great challenge that greatly affects the long-term compliance to PAP therapy.

Methods

This article discusses the different types of masks that can be used in patients with OSA, including the differences between nasal, oro-nasal, and total face masks, breathing during wakefulness and sleep, and the impact of interface type on upper airway patency and mask fitting. We also discuss the steps to be considered in choosing the proper interface and potential problems that may arise during long-term use.

Results and conclusion

Current evidence suggests that the nasal mask is better tolerated, requires lower pressure to eliminate obstructive respiratory events, and is associated with a better sleep quality and better PAP therapy compliance. Nevertheless, the best mask is the one that patient will wear.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1(8225):862–865

    Article  CAS  PubMed  Google Scholar 

  2. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine : JCSM: official publication of the American Academy of Sleep Medicine 5(3):263–276

    Google Scholar 

  3. Kakkar RK, Berry RB (2007) Positive airway pressure treatment for obstructive sleep apnea. Chest 132(3):1057–1072

    Article  PubMed  Google Scholar 

  4. Beecroft J, Zanon S, Lukic D, Hanly P (2003) Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest 124(6):2200–2208

    Article  PubMed  Google Scholar 

  5. Gleeson K, Zwillich CW, Braier K, White DP (1986) Breathing route during sleep. Am Rev Respir Dis 134(1):115–120

    CAS  PubMed  Google Scholar 

  6. Georgalas C (2011) The role of the nose in snoring and obstructive sleep apnoea: an update. Eur Arch Otorhinolaryngol 268(9):1365–1373

    Article  PubMed  PubMed Central  Google Scholar 

  7. Schwartz AR, Smith PL, Wise RA, Gold AR, Permutt S (1985) Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure. J Appl Physiol 64(2):535–542

    Google Scholar 

  8. Ayappa I, Rapoport DM (2003) The upper airway in sleep: physiology of the pharynx. Sleep Med Rev 7(1):9–33

    Article  PubMed  Google Scholar 

  9. Pevernagie DA, De Meyer MM, Claeys S (2005) Sleep, breathing and the nose. Sleep Med Rev 9(6):437–451

    Article  PubMed  Google Scholar 

  10. Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS (2003) Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 22(5):827–832

    Article  CAS  PubMed  Google Scholar 

  11. Miyamoto K, Ozbek MM, Lowe AA, Sjoholm TT, Love LL, Fleetham JA, Ryan CF (1999) Mandibular posture during sleep in patients with obstructive sleep apnoea. Arch Oral Biol 44(8):657–664

    Article  CAS  PubMed  Google Scholar 

  12. Meurice JC, Marc I, Carrier G, Series F (1996) Effects of mouth opening on upper airway collapsibility in normal sleeping subjects. Am J Respir Crit Care Med 153(1):255–259

    Article  CAS  PubMed  Google Scholar 

  13. Fitzpatrick MF, Driver HS, Chatha N, Voduc N, Girard AM (1985) Partitioning of inhaled ventilation between the nasal and oral routes during sleep in normal subjects. J Appl Physiol 94(3):883–890

    Article  Google Scholar 

  14. Van de Graaff WB (1988) Thoracic influence on upper airway patency. J Appl Physiol (1985) 65(5):2124–2131

    CAS  Google Scholar 

  15. Bachour A, Maasilta P (2004) Mouth breathing compromises adherence to nasal continuous positive airway pressure therapy. Chest 126(4):1248–1254

    Article  PubMed  Google Scholar 

  16. Ruhle KH, Nilius G (2008) Mouth breathing in obstructive sleep apnea prior to and during nasal continuous positive airway pressure. Respiration; international review of thoracic diseases 76(1):40–45

    Article  PubMed  Google Scholar 

  17. Jefferson Y (2010) Mouth breathing: adverse effects on facial growth, health, academics, and behavior. Gen Dent 58(1):18–25 quiz 26-17, 79-80

    PubMed  Google Scholar 

  18. 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. Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 40(6):658–668

    Article  Google Scholar 

  19. Andrade RG, Madeiro F, Piccin VS, Moriya HT, Schorr F, Sardinha PS, Gregorio GM, Genta PR, Lorenzi-Filho G (2016) Impact of acute changes in CPAP flow route in sleep apnea treatment. Chest

  20. Smith PL, Wise RA, Gold AR, Schwartz AR, Permutt S (1985) Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 64(2):789–795

    Google Scholar 

  21. Nascimento JA, de Santana CT, Moriya HT, Fernandes PH, de Andrade RG, Genta PR, Lorenzi-Filho G, Nakagawa NK (2016) Body position may influence oronasal CPAP effectiveness to treat OSA. J Clin Sleep Med 12(3):447–448

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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(4):1112–1118

    Article  PubMed  Google Scholar 

  23. Zhu X, Wimms AJ, Benjafield AV (2013) Assessment of the performance of nasal pillows at high CPAP pressures. J Clin Sleep Med 9(9):873–877

    PubMed  PubMed Central  Google Scholar 

  24. Ryan S, Garvey JF, Swan V, Behan R, McNicholas WT (2011) Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy. J Sleep Res 20(2):367–373

    Article  PubMed  Google Scholar 

  25. Ebben MR, Oyegbile T, Pollak CP (2012) The efficacy of three different mask styles on a PAP titration night. Sleep Med 13(6):645–649

    Article  PubMed  Google Scholar 

  26. 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(6):619–624

    Article  PubMed  Google Scholar 

  27. Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B, Grillet Y, Muir JF, Levy P, Series F, Pepin JL, Scientific Council of The Sleep Registry of the French Federation of (2013) Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One 8(5):e64382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Mortimore IL, Whittle AT, Douglas NJ (1998) Comparison of nose and face mask CPAP therapy for sleep apnoea. Thorax 53(4):290–292

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Westhoff M, Litterst P (2015) Obstructive sleep apnoea and non-restorative sleep induced by the interface. Sleep & breathing = Schlaf & Atmung 19(4):1317–1325

    Article  Google Scholar 

  30. Schorr F, Genta PR, Gregorio 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(2):503–505

    Article  PubMed  Google Scholar 

  31. Smith PL, O’Donnell CP, Allan L, Schwartz AR (2003) A physiologic comparison of nasal and oral positive airway pressure. Chest 123(3):689–694

    Article  PubMed  Google Scholar 

  32. Anderson FE, Kingshott RN, Taylor DR, Jones DR, Kline LR, Whyte KF (2003) A randomized crossover efficacy trial of oral CPAP (Oracle) compared with nasal CPAP in the management of obstructive sleep apnea. Sleep 26(6):721–726

    PubMed  Google Scholar 

  33. Khanna R, Kline LR (2003) A prospective 8 week trial of nasal interfaces vs. a novel oral interface (Oracle) for treatment of obstructive sleep apnea hypopnea syndrome. Sleep Med 4(4):333–338

    Article  PubMed  Google Scholar 

  34. Knowles SR, O’Brien DT, Zhang S, Devara A, Rowley JA (2014) Effect of addition of chin strap on PAP compliance, nightly duration of use, and other factors. J Clin Sleep Med 10(4):377–383

    PubMed  PubMed Central  Google Scholar 

  35. Bhat S, Gushway-Henry N, Polos PG, DeBari VA, Riar S, Gupta D, Lysenko L, Patel D, Pi J, Chokroverty S (2014) The efficacy of a chinstrap in treating sleep disordered breathing and snoring. J Clin Sleep Med 10(8):887–892

    PubMed  PubMed Central  Google Scholar 

  36. Brill A-K (2014) How to avoid interface problems in acute noninvasive ventilation. Breathe 10:231–242

    Article  Google Scholar 

  37. Meduri GU, Abou-Shala N, Fox RC, Jones CB, Leeper KV, Wunderink RG (1991) Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 100(2):445–454

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia

    Ahmed S. BaHammam, Smitha George, Karen Lorraine Acosta, Kashmira Barataman & Divinagracia E. Gacuan

  2. Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia

    Ahmed S. BaHammam, Smitha George, Karen Lorraine Acosta, Kashmira Barataman & Divinagracia E. Gacuan

  3. Philips, Respironics, Murrysville, PA, USA

    Tripat Singh

Authors
  1. Ahmed S. BaHammam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tripat Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Smitha George
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karen Lorraine Acosta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kashmira Barataman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Divinagracia E. Gacuan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed S. BaHammam.

Ethics declarations

Funding

This study was supported by a grant from the National Plan for Science and Technology Program by the King Saud University Project in Saudi Arabia. The sponsor had no role in the design or conduct of this research.

Conflict of interest

TS is an employee of Philips/Respironics. He declares that he has no proprietary or financial interests that could be construed or considered to be a potential conflict of interest that might have influenced the views expressed in this manuscript. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

BaHammam, A.S., Singh, T., George, S. et al. Choosing the right interface for positive airway pressure therapy in patients with obstructive sleep apnea. Sleep Breath 21, 569–575 (2017). https://doi.org/10.1007/s11325-017-1490-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-017-1490-9

Keywords

Search

Navigation