In search of a better <scp>CPAP</scp> interface: A network meta‐analysis comparing nasal masks, nasal pillows and oronasal masks

Chen, Li‐Yang; Chen, Yung-Hsuan; Hu, Shih-Wen; Lin, Ming‐Tzer; Lee, Pei-Lin; Chiang, An Jen; Tu, Yu‐Kang

doi:10.1111/jsr.13686

Cited by 13 publications

(9 citation statements)

References 54 publications

(140 reference statements)

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“…Even if the majority of studies advocate for nasal mask usage rather than oronasal one [12], there are conflicting opinions regarding nasal mask type [7][8][9][10][11][12][13][14]. Nasal pillows have been designed to overcome the perceived adverse effects of nasal masks.…”

Section: Resultsmentioning

confidence: 99%

The Importance of Appropriate PAP Silicone Mask Selection in Sleep Apnea Management

Vlad,

Stefanescu,

Hainarosie

2023

Mater. Plast.

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Positive airway pressure (PAP) is the standard treatment for patients with moderate to severe obstructive sleep apnea, especially when a correctable anatomic obstacle is not identified. The PAP efficiency strongly depends on the appropriate use during sleep. Despite the recent advancements in PAP interface designs, overall adherence to therapy remains low. The main sources of discomfort consist of air leakage and mask overtightening leading to skin problems. However, these disadvantages have been partially reduced by new interfaces like nasal pillows that have the capacity to reduce the contact of the silicone cushion with the skin, reducing the chances of skin irritation. At the same time, assuring a better seal prevents air leakage and is particularly useful in patients with internal valve insufficiency. We present a case of a 57-year-old patient with severe sleep apnea syndrome whose efficient treatment was delayed by an inadequate PAP mask prescription at diagnosis. Due to low treatment compliance secondary to the perceived adverse effects of the oronasal mask, the patient decided to discontinue treatment for two years with subsequent aggravation of sleep apnea symptoms. The patient’s sensitivity to the silicone mask cushion and treatment ineffectiveness due to internal valve collapse were the main causes of treatment failure. After changing of PAP interface, the patient achieved long-term compliance. Our case report reflects the importance of choosing the most suitable PAP interface in accordance with the patient’s particularities. In the absence of this approach, appropriate treatment might be delayed with detrimental consequences, especially in severe cases. Considering PAP adherence following therapy initiation usually predicts long-term compliance, finding the best mask design from the beginning can predict therapeutic success.

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Section: Resultsmentioning

confidence: 99%

The Importance of Appropriate PAP Silicone Mask Selection in Sleep Apnea Management

Vlad,

Stefanescu,

Hainarosie

2023

Mater. Plast.

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“…Unobstructed upper airways are an important condition for an uncomplicated PAP treatment of OSA [ 15 , 18 , 24 ]. In some nasal obstruction cases, we can provide treatment by applying PAP through a full-face mask, but compliance is higher when the patients use a nasal mask [ 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Continuous Positive Airway Pressure Adherence Based on Nasal Endoscopy and the Measurement of Nasal Patency—A Prospective Study

Knížek

Kotulek²,

Brothánková

et al. 2023

Life

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The gold standard for treating obstructive sleep apnea in adults is continuous positive airway pressure (CPAP). However, it can be difficult to convince patients to adhere to this therapy. The aim of this study was to determine the relationship between nasal endoscopy findings/nose patency and CPAP adherence. Material and methods: A cohort of 450 consecutive patients suspected of having OSA were prospectively enrolled. For further analyses, 47 OSA patients undergoing CPAP treatment were selected (13 females and 34 males, average age, 65.3 years, BMI 34.1, apnea-hypopnea index. AHI 51.0). The patients were divided into two groups: patients with good CPAP adherence (n = 35) and patients who did not adhere to CPAP therapy (n = 12). The influence of nasal endoscopy and flow measurement on CPAP adherence was explored. Results: We found a statistical independence between adherence to CPAP and AHI (p = 0.124), T90 (p = 0.502), endoscopic findings (p = 0.588) and nasal patency measured by a flowmeter (p = 0.498). Conclusions: In our studied sample, endoscopic findings and nasal patency measured by a flowmeter were not predictors of CPAP non-adherence in the first year of the treatment. Our data show that while an endoscopic finding in the nasal cavity could indicate that a patient has a severe obstruction, compliance with CPAP therapy is not reduced in these patients and neither is it reduced with a decrease in nasal flow, according to our observation.

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“…Work should be undertaken to risk stratify those who are unlikely to use CPAP therapy and targeted intervention made for these patients. Work to optimise patient comfort of PAP, for example through optimal mask interface, is ongoing [77], and other interventions such as emotional self-regulation via mindfulness are of interest [78 & ] Other therapies for OSA could prove beneficial. Mandibular advancement devices (MADs), which reduce airway obstruction through advancement of the jaw, are a second line therapy.…”

Section: Treatmentmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions

Chambers,

Bamber,

Singh

2023

Current Opinion in Pulmonary Medicine

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Purpose of review Obstructive sleep apnoea (OSA) is an increasingly common pathology that all those involved in perioperative care will come across. Patients with the condition present a challenge at many stages along the perioperative journey, not least because many patients living with OSA are unaware of their diagnosis. Key interventions can be made pre, intra-, and postoperatively to improve outcomes. Knowledge of screening tools, diagnostic tests, and the raft of treatment options are important for anyone caring for these patients. Recent findings Recent literature has highlighted the increasing complexity of surgical patients and significant underdiagnosis of OSA in this patient population. Work has demonstrated how and why patients with OSA are at a higher perioperative risk and that effective positive airways pressure (PAP) therapy can reduce these risks, alongside evidencing how best to optimise adherence to therapy, a key issue in OSA. Summary OSA, and particularly undiagnosed OSA, presents a huge problem in the perioperative period. Perioperative PAP reduces the risk of postoperative complications but adherence remains an issue. Bespoke perioperative pathways should be developed to identify and optimise high risk patients, although at present evidence on how best to achieve this is lacking.

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In search of a better CPAP interface: A network meta‐analysis comparing nasal masks, nasal pillows and oronasal masks

Abstract: Until now, no study has directly network meta-analysed the impact of nasal masks, nasal pillows and oronasal masks on continuous positive airway pressure therapy in

Cited by 13 publications

References 54 publications

The Importance of Appropriate PAP Silicone Mask Selection in Sleep Apnea Management

The Importance of Appropriate PAP Silicone Mask Selection in Sleep Apnea Management

Outcome of Continuous Positive Airway Pressure Adherence Based on Nasal Endoscopy and the Measurement of Nasal Patency—A Prospective Study

Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions

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