Oronasal masks require higher levels of positive airway pressure than nasal masks to treat obstructive sleep apnea

Bettinzoli, Michela; Taranto‐Montemurro, Luigi; Messineo, Ludovico; Corda, Luciano; Redolfi, Stefania; Ferliga, Mauro; Tantucci, Claudio

doi:10.1007/s11325-014-0954-4

Cited by 27 publications

(26 citation statements)

References 23 publications

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“…Our study was also from a single center, and it would be important to replicate these findings in other sleep services to strengthen our conclusions. Despite this, our results do mirror those of Bettinzoli et al 12 In summary, oronasal masks are associated with higher CPAP requirements and higher residual AHI compared to nasal and nasal pillow masks. Patients using oronasal masks are also significantly more likely to require very high CPAP levels (≥ 15 cm H 2 O) than nasal type interfaces.…”

Section: Discussionsupporting

confidence: 53%

“…Bettinzoli et al performed a retrospective study on 109 subjects with moderate-severe OSA. 12 They demonstrated a 1.2 cm H 2 O higher CPAP pressure with oronasal masks, as well as a higher residual AHI. Finally, Borel et al looked specifically at predictors of long-term CPAP usage.…”

Section: Discussionmentioning

confidence: 86%

“…In support of this is the fact that multiple other studies have demonstrated similar findings. [10][11][12] In addition, a recent study by Ebben et al has demonstrated that nasal masks were more effective at opening the upper airway in the retropalatal region than oronasal masks at a range of CPAP pressures. 22 The authors hypothesized that this may explain the higher residual AHI with oronasal masks seen in some studies.…”

Section: Discussionmentioning

confidence: 99%

“…This point is highlighted by the fact that in the study by Teo et al, 43% of patients had nasal to oronasal mask pressures differences of 2 cm H 2 O or more. In contrast, Bettinzoli et al 12 demonstrated that the required therapeutic CPAP level was higher when administered through an oronasal mask compared to nasal interfaces. In their cohort, the only independent predictor of therapeutic CPAP level was mask type, with no independent effect noted from either OSA severity or patient body mass index (BMI).…”

Section: Brief Summarymentioning

confidence: 90%

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Oronasal Masks Require a Higher Pressure than Nasal and Nasal Pillow Masks for the Treatment of Obstructive Sleep Apnea

Deshpande

Joosten

Turton

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Oronasal masks are frequently used for continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). The aim of this study was to (1) determine if CPAP requirements are higher for oronasal masks compared to nasal mask interfaces and (2) assess whether polysomnography and patient characteristics differed among mask preference groups. Methods: Retrospective analysis of all CPAP implementation polysomnograms between July 2013 and June 2014. Prescribed CPAP level, polysomnography results and patient data were compared according to mask type (n = 358). Results: Oronasal masks were used in 46%, nasal masks in 35% and nasal pillow masks in 19%. There was no difference according to mask type for baseline apnea-hypopnea index (AHI), body mass index (BMI), waist or neck circumference. CPAP level was higher for oronasal masks, 12 (10-15.5) cm H 2 O compared to nasal pillow masks, 11 (8-12.5) cm H 2 O and nasal masks, 10 (8-12) cm H 2 O, p < 0.0001 (Median [interquartile range]). Oronasal mask type, AHI, age, and BMI were independent predictors of a higher CPAP pressure (p < 0.0005, adjusted R 2 = 0.26.). For patients with CPAP ≥ 15 cm H 2 O, there was an odds ratio of 4.5 (95% CI 2.5-8.0) for having an oronasal compared to a nasal or nasal pillow mask. Residual median AHI was higher for oronasal masks (11.3 events/h) than for nasal masks (6.4 events/h) and nasal pillows (6.7 events/h), p < 0.001. Conclusions: Compared to nasal mask types, oronasal masks are associated with higher CPAP pressures (particularly pressures ≥ 15 cm H 2 O) and a higher residual AHI. Further evaluation with a randomized control trial is required to definitively establish the effect of mask type on pressure requirements. Keywords: obstructive sleep apnea, CPAP, treatment, mask, nasal pillows, nasal mask, oronasal mask Commentary: A commentary on this article appears in this issue on page 1209. Citation: Deshpande S, Joosten S, Turton A, Edwards BA, Landry S, Mansfield DR, Hamilton GS. Oronasal masks require a higher pressure than nasal and nasal pillow masks for the treatment of obstructive sleep apnea. J Clin Sleep Med 2016;12(9):1263-1268. I NTRO DUCTI O NObstructive sleep apnea (OSA) is characterized by excessive daytime sleepiness due to recurrent episodes of partial (hypopnea) or complete (apnea) obstruction of the upper airway during sleep. OSA is highly prevalent and moderate-severe OSA is reported to affect 17% of men and 9% of women older than 50 years.1 Untreated OSA is associated with significant morbidity and mortality, with increased risk of hypertension, depression, motor vehicle accidents, cardiovascular disease, and premature death.2-5 The mainstay of therapy for OSA is nocturnal continuous positive airway pressure (CPAP), which prevents collapse by pneumatically splinting the upper airway. CPAP has been shown to reduce daytime somnolence, improve quality of life, and improve nocturnal oxygen saturation. 6 CPAP has also been shown to reduce blood pressure, and in severe OSA, c...

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Brief Summarymentioning

confidence: 90%

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Oronasal Masks Require a Higher Pressure than Nasal and Nasal Pillow Masks for the Treatment of Obstructive Sleep Apnea

Deshpande

Joosten

Turton

et al. 2016

Journal of Clinical Sleep Medicine

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“…Bedre forståelse av patofysiologien er en forutsetning for god individualisert terapi. Ved CPAP-behandling er det vist at bruk av munn-nese-maske gir økt tendens til øvre luftveiskollaps og behov for høyere trykk enn bruk av nesemaske (14). For pasienter med sterk tendens til luftveissammenfall kan munn-nese-maske derfor vaere ugunstig.…”

Section: Behandlingunclassified

Obstruktiv søvnapné

Engstrøm¹,

Beiske

Hrubos‐Strøm

et al. 2015

Tidsskriftet

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Oronasal masks require higher levels of positive airway pressure than nasal masks to treat obstructive sleep apnea

Abstract: Therapeutic CPAP level for OSAH is higher when administered via oronasal mask, leaving more residual events. These findings suggest that nasal mask should be the first choice for OSAH treatment.

Cited by 27 publications

References 23 publications

Oronasal Masks Require a Higher Pressure than Nasal and Nasal Pillow Masks for the Treatment of Obstructive Sleep Apnea

Oronasal Masks Require a Higher Pressure than Nasal and Nasal Pillow Masks for the Treatment of Obstructive Sleep Apnea

Obstruktiv søvnapné

International Consensus Statement on Obstructive Sleep Apnea

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