Somnologie - Schlafforschung und Schlafmedizin

, Volume 12, Issue 4, pp 294–298 | Cite as

Mund und Maskenleckage bei Kontrolluntersuchungen

ORIGINALARBEIT
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Zusammenfassung

Unter Applikation von nasalem Überdruck (CPAP) wird normalerweise eine ventrale Velagerung des weichen Gaumens erreicht, hierdurch entwickelt sich ein Verschluss des Oropharynx zur Mundhöhle hin und in der Mundhöhle ist der Überdruck nicht wirksam. Dieser Verschluss wird auch soft palat seal bezeichnet. Aus verschiedenen Gründen kann dieser Verschluss jedoch unvollständig sein und Patienten können Mundatmung unter nasalem CPAP entwickeln. Beim Auftreten einer hinreichend großen Mundleckage kann kein suffizienter Therapiedruck zur Vermeidung des oropharyngealen Kollapses aufgebaut werden. Dies begünstigt zusätzlich Mundatmung.

Leckagen infolge Mundatmung unter CPAP führen zu einem erhöhten Flow des Therapiegerätes, um den Druck konstant zu halten. Der erhöhte Luftfluss führt zu den bekannten Nebenwirkungen wie Trockenheit an den Nasen- und Rachenschleimhäuten. Konsekutiv schwellen die Nasenschleimhäute an und es resultiert ein höherer Fluss-Widerstand in der Nase. Dies führt zu einem weiteren Abfall des effektiven Therapiedrucks im Oropharynx.

Subjektiv fühlen die Patienten sich durch die Rhinitis gestört. Eine verringerte Compliance oder gar Inakzeptanz von CPAP können die Folge sein.

Es liegen nur wenige Untersuchungen zum Effekt von Kontrolluntersuchungen bei Mund- und Masken-Leckagen vor. In den vorliegenden Studien wird ein Evidenzgrad besser als 4 nicht erreicht. In einer Vergleichsstudie zeigten Patienten mit Mundatmung über 70 Prozent der Gesamtschlafzeit im Verlauf eine geringere Compliance als Patienten mit einer geringen Mundatmung. Damit liegen erste Daten vor, die auf die Bedeutung von Mundleckagen hinweisen. Bei verminderter Compliance sollten Kontrolluntersuchungen neben den Nasen-Rachen-Beschwerden die Leckagedaten der Geräte berücksichtigen.

Schlüsselwörter

OSAS CPAP Nebenwirkungen Masken Leckage 

Mouth breathing and mask leakage during check-ups

Summary

During the application of nasal continuous positive airway pressure (CPAP), the velum is normally shifted in the ventral direction and an occlusion of the oropharynx against the oral cavity results. Therefore, positive airway pressure is not effective in the oral cavity. This occlusion is also called soft palatal seal. Due to different reasons; however, the occlusion can be incomplete and therefore patients can develop mouth breathing under nasal CPAP.

Beyond a certain threshold of mouth leakage, which varies individually, the CPAP device Is no longer capable of building up enough pressure to avoid oropharyngeal collapsing. This also promotes oral breathing under nasal CPAP. Leakage due to oral breathing leads to a higher flow of the CPAP machine in order to maintain the pressure. The amplified airflow leads to known adverse effects, such as dryness of nasal and oral mucosa. Consecutively blood flow in nasal mucosa increases and nasal obstruction worsens, leading to further reduction of the effective therapy pressure in the oropharynx. The patients feel disturbed by the rhinitis, and lower compliance or a total refusal of CPAP can be the consequence.

There are only scarse studies trials on the effect of follow-up examinations with regard to the effect of mouth breathing and mask leakages. In these trials no level of evidence better than 4 is reached. In a comparative study, patients with mouth breathing during more than 70 % of the entire sleeping time showed lower compliance than patients with less mouth breathing. This study is suggestive of the negative effect of mouth breathing on the compliance of CPAP. Therefore, when insufficient compliance is uncovered, check-ups should quantify the mucosa side effects and the leakage data from the CPAP machine.

Key words

OSAS CPAP adverse effects masks leakage 
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Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.Klinik für Pneumologie, Klinik AmbrockUniversität Witten-HerdeckeHagenGermany

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