Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea

Abstract

Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

Effect of Heated Humidification on CPAP Therapy Adherence in Subjects With Obstructive Sleep Apnea With Nasopharyngeal Symptoms

“…According to the clinical guidelines for the evaluation, management and long-term care of obstructive sleep apnea in adults, a nasal mask is the preferred delivery route, since previous studies have demonstrated that a full face mask may be associated with lower CPAP adherence. 14,18 We also demonstrated that nasopharyngeal symptoms were better with the addition of heated humidification, particularly for dry/sore throat. Dry throat/sore throat is a known frequent complaint of the subjects using CPAP.…”

Choosing the right mask for your Asian patient with sleep apnoea: A randomized, crossover trial of CPAP interfaces

“…There is a paucity of evidence to guide mask interface selection . Oronasal masks have been reported to be associated with poorer adherence and increased residual apnoea–hypopnoea index (AHI) . Hence, current practice usually is to initiate therapy with nasal masks or pillows, reserving oronasal masks for patients who are intolerant or report significant nasal obstruction or mouth breathing.…”

Impact of different nasal masks on CPAP therapy for obstructive sleep apnea: a randomized comparative trial

“…Therefore, many studies have investigated factors that might influence compliance with nocturnal CPAP to identify the best ways to maximize compliance. Along with patient education , clinical support , and behavioral interventions , CPAP equipment, including the interface, has been shown to be an important factor in determining compliance with therapy . The current results add to the body of evidence in this area.…”