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

BaHammam, Ahmed S.; Singh, Tripat Deep; George, Smitha; Acosta, Karen Lorraine; Barataman, Kashmira; Gacuan, Divinagracia E.

doi:10.1007/s11325-017-1490-9

Cited by 24 publications

(10 citation statements)

References 34 publications

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“…The development of nasal side effects with CPAP treatment may be related to the induction of this type of inflammatory response. However, in another study, it was shown that inflammatory markers in sputum of OSA patients before and after use of CPAP for a month remained unchanged and an increase in airway hyperresponsiveness was observed . In other work, application of 10 cm H 2 O n‐CPAP for 5 h caused a threefold increase in the number of neutrophils found in the nasal mucosa .…”

Section: Pressure‐related Side Effectsmentioning

confidence: 89%

Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea

Ghadiri

Grunstein

2020

Respirology

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CPAP is considered the gold standard treatment in OSA and is highly efficacious in controlling OSA symptoms. However, treatment effectiveness is limited because of many factors including low adherence due to side effects. This review highlights the range of side effects associated with CPAP therapy in patients with OSA. This information is important for the initiation of patients onto CPAP as well as their continued care while on treatment, given the increase in non-medically supervised CPAP care models in use globally.

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Section: Pressure‐related Side Effectsmentioning

confidence: 89%

Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea

Ghadiri

Grunstein

2020

Respirology

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“…Therefore, in this context, it is important to understand the physiological effects of positive airway pressure applied through different interfaces on upper airway dynamics. 6,36 To understand the effects of different interfaces on upper airway patency, we need to briefly review the difference between nose breathing and mouth breathing. 37 When breathing occurs through the mouth, there is an increase in upper airway resistance and an increased tendency to develop upper airway obstruction.…”

Section: Interface Type and Upper Airway Obstructionmentioning

confidence: 99%

“…For interface choice in patients with stable sleep-disordered breathing, readers are referred to a recently published review. 6…”

mentioning

confidence: 99%

Choosing the Proper Interface for Positive Airway Pressure Therapy in Subjects With Acute Respiratory Failure

et al. 2017

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Noninvasive ventilation is an effective treatment for a significant proportion of patients with acute respiratory failure. The success of noninvasive ventilation, however, depends on several factors, a major one being the selection of the proper interface. The choice and application of the interface in patients with acute respiratory failure is a considerable challenge for any treatment team. This review discusses the different types of interfaces that can be used in patients with acute respiratory failure, the differences between nasal, oro-nasal, and total face masks and the helmet, as well as the effect of interface type on treatment success and upper airway patency, mask fitting, problems related to the interface, and the relationship between ventilator type and interface choice.

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“…Oronasal breathing may adversely impact OSA patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes (1). Self-reported oronasal breathing is a common reason for oronasal CPAP prescription (3,20,27). However, oronasal CPAP has been linked to poorer outcomes compared with nasal CPAP (4,9).…”

Section: Introductionmentioning

confidence: 99%

“…Although oronasal CPAP is associated with poorer adherence, a higher residual apnea-hypopnea index (AHI), and higher therapeutic levels than nasal CPAP, 25-50% of CPAP prescriptions are for oronasal CPAP (4, 5a, 7-9). Self-reported oronasal breathing and nasal symptoms often influence the choice of oronasal masks for CPAP treatment of OSA patients (3,27). Self-reported nasal obstruction has been shown to be poorly associated with objective measures of nasal patency (19,28).…”

Section: Introductionmentioning

confidence: 99%

Predictors of oronasal breathing among obstructive sleep apnea patients and controls

Nascimento

Genta

Fernandes

et al. 2019

Journal of Applied Physiology

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Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common ( P = <0.001) among OSA patients than controls while awake (62 ± 44 vs. 5 ± 6%) and during sleep (59 ± 39 vs. 25 ± 21%, respectively). Oronasal breathing was associated with OSA severity ( P = 0.009), age ( P = 0.005), body mass index ( P = 0.044), and neck circumference ( P = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (κ = −0.12) and asleep (κ = −0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP. NEW & NOTEWORTHY Continuous positive airway pressure (CPAP) interface choice for obstructive sleep apnea (OSA) patients is often guided by nasal symptoms and self-reported breathing route. We showed that oronasal breathing can be predicted by anthropometric measurements and OSA severity but not by self-reported oronasal breathing. Self-reported breathing and nasal symptoms should not be considered for CPAP interface choice.

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

Abstract: 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.

Cited by 24 publications

References 34 publications

Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea

Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea

Choosing the Proper Interface for Positive Airway Pressure Therapy in Subjects With Acute Respiratory Failure

Predictors of oronasal breathing among obstructive sleep apnea patients and controls

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