Higher Effective Oronasal versus Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnea: Effect of Mandibular Stabilization

Kamińska, Marta; Montpetit, Andrée; Mathieu, Annie; Jobin, Vincent; Morisson, Florence; Mayer, Pierre

doi:10.1155/2014/408073

Cited by 34 publications

(30 citation statements)

References 25 publications

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“…One postulated mechanism is that pressure delivered through the mouth pushes the tongue and soft tissues backwards, resulting in upper airway obstruction . Alternatively, the force of the oronasal mask against the mandible may push the jaw backwards, resulting in more upper airway obstruction . Movement of the soft palate in a flagging motion with the use of oronasal masks, resulting in upper airway turbulence, has also been postulated to contribute to reduced efficacy .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…This would suggest that there are specific aspects that predispose them to higher pressure requirements while using an oronasal mask. Kaminska et al () have shown that posterior mandibular displacement partially contributes to this phenomenon in these individuals through application of a mandibular advancement device to stabilise the jaw. This work is further supported by a recent experimental study by Andrade et al (), where they demonstrate decreases to either the retroglossal or retropalatal area with use of an oronasal mask.…”

Section: Discussionmentioning

confidence: 99%

A randomised crossover trial comparing nasal masks with oronasal masks: No differences in therapeutic pressures or residual apnea‐hypopnea indices

Shirlaw

Duce

Milosavljevic

et al. 2018

Journal of Sleep Research

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In treating obstructive sleep apnea (OSA), the use of oronasal masks with continuous positive airway pressure (CPAP) has been reported to increase pressure levels and reduce compliance. These reports come mostly from large observational studies. In this study, we examined the impact that oronasal masks have on 95th centile pressures, the residual apnea-hypopnea index (AHI) and compliance compared with nasal masks. A randomised crossover design was implemented. Participants already established on CPAP were randomly allocated to a nasal mask or oronasal mask with auto-titrating positive airway pressure (APAP) for 2 weeks. Participants then crossed over to use the alternate mask for another 2 weeks. Seventy-one participants were recruited but only 60 completed the trial. There were no differences in median 95th centile pressure (nasal, 11.5 cm H O; oronasal, 11.7 cm H O; p = 0.115), median residual AHI (nasal, 4.9 events/hr; oronasal, 5.3 events/hr; p = 0.234) or median compliance (nasal, 7.3 hr/night; oronasal, 7.3 hr/night; p = 0.961). Only four patients had 95th centile pressures that were at least 1.5 cm H O greater with oronasal masks. Oronasal masks do not systematically increase therapeutic CPAP requirements. Rather, a small subset of patients display significant differences in CPAP levels.

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“…In support of this, in a small study of six subjects, Kaminska et al showed that adding a mandibular advancement splint to CPAP with an oronasal mask enabled the CPAP requirement to be significantly lowered in three of the subjects. 8 Furthermore, mouth opening is an inherent feature of oronasal mask use, and mouth opening has previously been demonstrated to increase upper airway collapsibility. 23 Another possible explanation is that breathing through the mouth with an oronasal mask leads to the soft palate being pushed posteriorly, which may counteract the opening forces of nasal airflow and lead to a narrower airway than seen when using a nasal mask.…”

Section: Discussionmentioning

confidence: 99%

“…The CPAP level required to treat OSA varies between individuals. It has been reported that selected patients require higher CPAP levels with oronasal masks compared to nasal masks 8 ; however, the literature on whether CPAP requirements differ according to mask type is conflicting. A Cochrane review in 2006 concluded that due to an inadequate number of studies addressing the issue, the optimal CPAP interface was unclear.…”

Section: Introductionmentioning

confidence: 99%

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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Higher Effective Oronasal versus Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnea: Effect of Mandibular Stabilization

Abstract: In subjects with OSA with higher oronasal than nasal Peff, this is partially explained by posterior mandibular displacement caused by the oronasal mask. Combination treatment with oronasal mask and MAD may be useful in some individuals if a nasal mask is not tolerated.

Cited by 34 publications

References 25 publications

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

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

A randomised crossover trial comparing nasal masks with oronasal masks: No differences in therapeutic pressures or residual apnea‐hypopnea indices

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

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