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Quantitative investigation of additional mask leakage during CPAP therapy

Quantitative Untersuchung der zusätzlichen Maskenleckage während der CPAP-Therapie

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Abstract

Objectives

The occurrence of mask leakages during the administration of nasal continuous positive airway pressure (CPAP) therapy for treating obstructive sleep apnoea syndrome (OSAS) leads to decreased compliance. Because of exhalation valves, all mask systems have a predefined amount of systematic mask leakage, thereby complicating measurement of any additional spontaneous leakage occurring during the night. In fact, relatively few studies have investigated the impact and amount of mask leakage in patients using CPAP.

Methods

Using a fourth-order polynomial, systematic leakage was modelled as the nonlinear relationship between mask pressure and leakage through the exhalation valves. The total leakage was measured in 22 patients, and additional leakage was calculated by subtracting the systematic from the measured total leakage during the night.

Results

A mean additional leakage of 6.9±7.4 l/min was found; however, some patients showed rather high mask leakages (up to 37.4 l/min) with high mask pressures, possibly indicating that not all nasal masks are equally suited for higher CPAP pressures.

Conclusions

The relevant mask leakages that were observed in some cases stress the importance of thorough monitoring of patients receiving CPAP therapy. Furthermore, all investigated patients were trained very extensively in our sleep lab, possibly indicating that intensive training may be an important factor for the rather low additional mask leakages.

Zusammenfassung

Ziel

Maskenleckagen während der Anwendung der nasalen kontinuierlichen Überdrucktherapie (CPAP) zur Behandlung der obstruktiven Schlafapnoe (OSAS) können zu verminderter Compliance führen. Alle Maskensysteme weisen eine vordefinierte systematische Maskenleckage aufgrund der Ausatemventile auf, was eine Messung der zusätzlichen spontanen Leckage während der Nacht erschwert. Daher gibt es nur wenige Studien, die den Einfluss und die Größe der Maskenleckage bei CPAP-Patienten untersucht haben.

Methoden

Die systematische Leckage wurde als nichtlinearer Zusammenhang zwischen Maskendruck und Leckage durch das Ausatemventil mit Hilfe eines Polynoms 4. Ordnung modelliert. Die Gesamtleckage wurde bei 22 Patienten gemessen und dann die zusätzliche Leckage durch Subtraktion der systematischen von der Gesamtleckage berechnet.

Ergebnisse

Eine mittlere zusätzliche Leckage von 6,9±7,4 l/min wurde gefunden, jedoch zeigten einige Patienten auch höhere Leckagen (bis zu 37,4 l/min) bei hohen Maskendrücken, was ein Hinweis dafür sein kann, dass nicht alle Masken gleich gut bei hohen CPAP-Drücken brauchbar sind.

Fazit

Die gefundenen, teilweise relevanten Maskenleckagen betonen die Wichtigkeit des gewissenhaften Monitorings von CPAP-Patienten. Jedoch wurden alle Patienten in unserem Labor sehr ausführlich geschult, was möglicherweise ein Hinweis sein kann, dass intensives Training ein wichtiger Faktor für die insgesamt eher niedrigen Leckagen bei der CPAP-Therapie sein kann.

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Interessenkonflikt

None declared.

Danksagung

This study was supported by an unrestricted grant from Heinen and Löwenstein, Bad Ems, Germany.

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Authors and Affiliations

  1. Dept. for Internal Medicine – Respiratory Medicine, Sleep Disorders Centre, Philipps University Marburg – Faculty of Medicine, Baldingerstraße, 35043, Marburg/Lahn, Deutschland

    S. Canisius MD, PhD, T. Ploch, K. Kesper, A. Loh, U. Koehler & A. Jerrentrup

Authors
  1. S. Canisius MD, PhD
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  2. T. Ploch
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  3. K. Kesper
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  4. A. Loh
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  5. U. Koehler
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  6. A. Jerrentrup
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Corresponding author

Correspondence to S. Canisius MD, PhD.

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Canisius, S., Ploch, T., Kesper, K. et al. Quantitative investigation of additional mask leakage during CPAP therapy. Somnologie 13, 18–23 (2009). https://doi.org/10.1007/s11818-008-0357-5

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  • DOI: https://doi.org/10.1007/s11818-008-0357-5

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