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Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial

  • Antoine Léotard
  • Matthieu Lesgoirres
  • Najeh Daabek
  • Marius LebretEmail author
  • Sebastien Bailly
  • Alain Verain
  • Fréderic Series
  • Jean-Louis Pépin
  • Jean-Christian Borel
Sleep Breathing Physiology and Disorders • Short Communication

Abstract

Purpose

Evidence for the management of CPAP-treated obstructive sleep apnea suggests that oronasal masks reduce mouth leaks at the expense of higher pressures and poorer adherence. Some authors have proposed the use of mandibular advancement devices in combination with nasal masks to address this. The aim of this study was to assess adherence to CPAP after 1 month’s use of a nasal mask with a mandibular advancement device and to compare adherence with an oronasal mask.

Methods

A randomized crossover trial design to assess whether a mandibular advancement device combined with a nasal mask would improve CPAP adherence compared to an oronasal mask.

Results

There was no improvement in CPAP adherence and self-reported interface-related pain was significantly higher with the combined treatment.

Conclusions

Although the combined treatment reduced pressures, likely by improving upper airway patency, it may only be appropriate for a small number of patients due to associated discomfort.

Trial registration

NCT01889472

Keywords

Continuous positive airway pressure Nasal mask Mandibular advancement device Treatment adherence and compliance Obstructive sleep apnea 

Notes

Acknowledgments

We would like to acknowledged Johanna Robertson (PT, PhD) for language editing.

Author contribution

Conception: J-C Borel, F Series; acquisition: M Lesgoirres, A Verain; data analysis: N Daabek, S Bailly; data interpretation: J-C Borel, M Lebret, A Léotard; drafting the work or revising it: A Léotard, J-C Borel, JL Pépin, M Lebret, F Series; agreeing with manuscript results and conclusions: all authors

Compliance with ethical standards

Conflict of interest

The authors M Lebret, M Lesgoirres, N Daabek, and J-C Borel are employees of AGIR à dom., a non-profit homecare provider. J-C Borel has received grants, personal fees, and non-financial support from Philips Healthcare and ResMed unrelated to the submitted work. M Lebret has received personal fees and non-financial support from Air liquid Medical System and Sefam unrelated to the submitted work. A Léotard, S Bailly, A Verain, F Series, and J-L Pépin declared that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Glossary

AHI

apnea–hypopnea index

BMI

body mass index

CPAP

continuous positive airway pressure

EDS

excessive daytime sleepiness

MAD

mandibular advancement device

NM

nasal mask

NM + MAD

nasal mask with associated mandibular advancement device

ONM

oronasal mask

OSAS

obstructive sleep apnea syndrome

QOL

quality of life

Supplementary material

11325_2018_1772_MOESM1_ESM.docx (148 kb)
ESM 1 (DOCX 147 kb)

References

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Antoine Léotard
    • 1
    • 2
  • Matthieu Lesgoirres
    • 3
  • Najeh Daabek
    • 1
    • 3
  • Marius Lebret
    • 1
    • 3
    Email author
  • Sebastien Bailly
    • 1
    • 2
  • Alain Verain
    • 2
  • Fréderic Series
    • 4
  • Jean-Louis Pépin
    • 1
    • 2
  • Jean-Christian Borel
    • 1
    • 3
  1. 1.HP2, INSERM U1042, University Grenoble AlpesGrenobleFrance
  2. 2.Sleep and Exercise Laboratory, Thorax-Vaisseaux DepartmentGrenoble-Alpes University HospitalSaint-Martin-d’HèresFrance
  3. 3.AGIR à dom. AssociationMeylanFrance
  4. 4.Centre de recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) Université LavalQuébecCanada

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