Oronasal mask may compromise the efficacy of continuous positive airway pressure on OSA treatment

Andrade, Rafaela Garcia Santos de; Madeiro, Fernanda; Genta, Pedro Rodrigues; Lorenzi-Filho, Geraldo

doi:10.1097/mcp.0000000000000318

Cited by 21 publications

(12 citation statements)

References 44 publications

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“…Our findings are particularly relevant in the light of the impact of the choice of interface on residual AHI. Oronasal masks may exacerbate or cause upper airway obstruction due to posterior displacement of the jaw and the tongue . Large observational studies and a recent RCT have demonstrated that residual AHI was lower with nasal masks than with oronasal masks.…”

Section: Discussionmentioning

confidence: 99%

“…Oronasal masks may exacerbate or cause upper airway obstruction due to posterior displacement of the jaw and the tongue. 25 Large observational studies 11 and a recent RCT 26 have demonstrated that residual AHI was lower with nasal masks than with oronasal masks. A recent meta-analysis summarizing these findings showed that oronasal masks were associated with greater CPAP pressure levels, higher residual AHI and poorer adherence than nasal masks.…”

Section: Figurementioning

confidence: 99%

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Partial failure of CPAP treatment for sleep apnoea: Analysis of the French national sleep database

et al. 2019

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Background and objective Continuous positive airway pressure (CPAP) is the first‐line therapy for obstructive sleep apnoea (OSA). Residual apnoea and/or hypopnoea events, that is an apnoea–hypopnoea index (AHI) > 5, during CPAP contribute to treatment drop‐out. The clinical scenarios triggering residual events during CPAP use are poorly described. Underlying co‐morbidities, especially cardiovascular diseases, lifestyle factors, OSA characteristics at diagnosis and type of mask have been suggested as potential contributors. Methods Patients from the prospective French sleep apnoea registry diagnosed with OSA (AHI ≥ 15 events/h) treated with CPAP were included. Logistic regression analysis identified factors associated with a risk of residual AHI > 5 events/h on CPAP. Results The 12 285 OSA patients were predominantly men (n = 8715, 70.9%), middle‐aged (58.2 (49.8; 66.1) years) and obese (median body mass index: 31.3 (27.7; 35.6) kg/m2). Most had an AHI ≤ 5 events/h (n = 9573, 77.9%) versus 22.1% with AHI > 5/h. The latter were less CPAP adherent (5.75 (4.01; 7.00) vs 6.00 (4.53; 7.00) h/night). In multivariable analysis, factors associated with residual AHI >5/h were male sex, age, sedentary lifestyle, OSA severity, cardiovascular co‐morbidities (heart failure and arrhythmia) and type of interface (orofacial mask versus nasal mask: OR = 2.15 (95%CI: 1.95; 2.37)). A subgroup analysis found that patients using pressures above 10 cm H2O were 1.43 (95% CI: 1.3; 1.57) times more likely to have residual AHI > 5/h. Conclusion Knowing about risk factors for residual apnoeic–hypopnoeic events may assist in the timely provision of personalized care including the type of PAP therapy, attention to co‐morbidities and choice of interface.

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Partial failure of CPAP treatment for sleep apnoea: Analysis of the French national sleep database

et al. 2019

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“…15 Nasal mask have been suggested to be more effective than oronasal masks in treating OSA, perhaps since the oral portion of the oronasal mask pushes the tongue backwards, thus blocking the pharynx. 79,80 The main disadvantage of CPAP lies in its adherence. Some studies have reported an adherence rate of only 29-68%, [81][82][83][84] and adherence does not seem to have improved over a 20-year period despite behavioral interventions and improvements in machine technology.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

et al. 2020

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Uvulopalatopharyngoplasty (UPPP) is the most common surgical treatment for adult patients with obstructive sleep apnea (OSA). Its short-term efficacy, as measured through polysomnography, is well-established and has been demonstrated in two randomized controlled trials in recent years. However, less is known about subjective sleep quality, longterm efficacy, and side effects after surgery. In addition, the reliability of the most widespread clinical test for selecting patients for surgery-the Friedman staging system-is unclear. The Friedman staging system uses a combination of tonsil size and tongue position to predict the likelihood of successful surgery. The objective of studies I and II was to evaluate the staging system by determining its inter-examiner agreement. In study I, 15 doctors evaluated the system by using it on each other. In study II, 14 doctors evaluated the system by using it on 12 patients with OSA. Cohen's kappa analysis was used. Kappa values of 1 represents perfect agreement, and values of 0 represent no more agreement than would have been expected through random chance. In study I, the median kappa was 0.36 for tongue position. In study II, the median kappa was 0.32 for tongue position, 0.62 for tonsil size, and 0.38 for the Friedman staging system. These findings correspond to poor agreement, indicating that the system is an uncertain method for selecting patients for UPPP. Uvulopalatopharyngoplasty was first described in the eighties. Since then, there has been several modifications. The modified UPPP used in this thesis includes a tonsillectomy and is performed with cold instruments. It is less radical to the palate compared to the original procedure. The objective of study III was to investigate whether modified UPPP improves sleep quality by using the Functional Outcomes of Sleep Questionnaire and the Karolinska Sleep Questionnaire. The study consisted of two parts: Part 1 was a randomized controlled trial with two study groups (intervention and controls), and Part 2 was a post-operative follow-up of all patients (intervention and controls who received delayed surgery) with an analysis of outcomes at six and 24 months after UPPP. In eight out of nine subscales, there were significant improvements between the intervention and controls in favor of UPPP. In addition, at the six-and 24-month post-operative follow-ups of all patients, eight out of nine subscales were significantly improved compared to the baseline. These findings suggest a real and lasting beneficial effect of UPPP on subjective sleep quality, although a placebo effect cannot be excluded.

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“…Although CPAP by oral mask for OSA has been reported in some small-scale studies to be as effective as CPAP by nasal mask 13,14 , oral masks are not popular in clinical practice 15 and have not been studied in stroke patients. Therefore, looking for alternative treatments for OSA in dysphagic stroke patients requiring nasogastric tube feeding is warranted.…”

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confidence: 99%

High-flow nasal cannula ventilation therapy for obstructive sleep apnea in ischemic stroke patients requiring nasogastric tube feeding: a preliminary study

Chen

et al. 2020

Sci Rep

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Obstructive sleep apnea (OSA) is associated with increasing risk of recurrent stroke and mortality. Nasogastric tubes used by dysphagic stroke patients may interfere with nasal continuous positive airway pressure (CPAP) due to air leakage. This study was evaluated the effects and short-term tolerability of high-flow nasal cannula (HFNC) therapy for OSA in stroke patients with nasogastric intubation. The HFNC titration study was performed in post-acute ischemic stroke patients with nasogastric intubation and OSA. Then, participants were treated with HFNC therapy in the ward for one week. Eleven participants (eight males) who were all elderly with a median age of 72 (IQR 67-82) years and a body mass index of 23.5 (IQR 22.0-26.6) completed the titration study. The HFNC therapy at a flow rate up to 50~60 L/min significantly decreased the apnea-hypopnea index from 52.0 events/h (IQR 29.9-61.9) to 26.5 events/h (IQR 3.3-34.6) and the total arousal index from 34.6 (IQR 18.6-42.3) to 15.0 (IQR 10.3-25.4). The oxygen desaturation index was also significantly decreased from 53.0 events/h (IQR 37.0-72.8) to 16.2 events/h (IQR 0.8-20.1), accompanied by a significant improvement in the minimum SpO 2 level. Finally, only three participants tolerated flow rates of 50~60 L/minute in one-week treatment period. Conclusively, HFNC therapy at therapeutic flow rate is effective at reducing the OSA severity in post-acute ischemic stroke patients with nasogastric intubation. Owing to the suboptimal acceptance, HFNC might be a temporary treatment option, and CPAP therapy is suggested after the nasogastric tube is removed.

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Oronasal mask may compromise the efficacy of continuous positive airway pressure on OSA treatment

Abstract: Nasal CPAP must be the first choice to treat OSA. Patients on oronasal mask should be carefully followed. VIDEO ABSTRACT.

Cited by 21 publications

References 44 publications

Partial failure of CPAP treatment for sleep apnoea: Analysis of the French national sleep database

Partial failure of CPAP treatment for sleep apnoea: Analysis of the French national sleep database

Eight‐Year Follow‐up of Modified Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

High-flow nasal cannula ventilation therapy for obstructive sleep apnea in ischemic stroke patients requiring nasogastric tube feeding: a preliminary study

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