RESUMO
Abstract Objective: Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA. A wide variety of masks are used during CPAP therapy. The aim of the study is to compare polysomnography outcomes during titration for different types of masks (oronasal, nasal and pillow) and assess the impact on PAP titration. Methods: We retrospectively analyzed all CPAP titration polysomnography for one year. Anthropometric data and baseline apnea severity were documented. Results: A total of 497 patients were evaluated. Nasal masks were used in 82.3% (n = 409), pillow in 14.1% (n = 70) and oronasal in 3.6% (n = 18). There was no difference according to body mass index and baseline apnea-hypopnea index among the groups. The oronasal group was older and had higher titrated CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency, more superficial N1 sleep and longer wake time after sleep onset. All other polysomnography outcomes were similar among the groups. The mean CPAP level was 11.6 ± 2.1 cm H2O for the oronasal mask, 10.1 ± 2.1 cm H2O for the nasal mask and 9.8 ± 2.2 cm H2O for the pillow. The residual apnea-hypopnea index was 10.4 ± 7.9 for the oronasal mask, 5.49 ± 5.34 events/h for the nasal mask and 4.98 ± 5.48 events/h for the pillow. The baseline apnea-hypopnea index was correlated with of a higher CPAP pressure for all the groups (p< 0.001 for the nasal group, p = 0.001 for the pillow group and p = 0.049 for the oronasal group). Body mass index and residual AHI were correlated with of a higher CPAP pressure for the nasal and pillow groups only (p < 0.001). Conclusion: The interface can have a significant impact on the effectiveness of PAP titration. Patients with oronasal masks have higher CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency and higher wake time after sleep onset. Oronasal masks should not be recommended as the first choice for apnea patients. Level of evidence: Level 3.
RESUMO
OBJECTIVE: Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA. A wide variety of masks are used during CPAP therapy. The aim of the study is to compare polysomnography outcomes during titration for different types of masks (oronasal, nasal and pillow) and assess the impact on PAP titration. METHODS: We retrospectively analyzed all CPAP titration polysomnography for one year. Anthropometric data and baseline apnea severity were documented. RESULTS: A total of 497 patients were evaluated. Nasal masks were used in 82.3% (nâ¯=â¯409), pillow in 14.1% (nâ¯=â¯70) and oronasal in 3.6% (nâ¯=â¯18). There was no difference according to body mass index and baseline apnea-hypopnea index among the groups. The oronasal group was older and had higher titrated CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency, more superficial N1 sleep and longer wake time after sleep onset. All other polysomnography outcomes were similar among the groups. The mean CPAP level was 11.6⯱â¯2.1â¯cm H2O for the oronasal mask, 10.1⯱â¯2.1â¯cm H2O for the nasal mask and 9.8⯱â¯2.2â¯cm H2O for the pillow. The residual apnea-hypopnea index was 10.4⯱â¯7.9 for the oronasal mask, 5.49⯱â¯5.34 events/h for the nasal mask and 4.98⯱â¯5.48 events/h for the pillow. The baseline apnea-hypopnea index was correlated with of a higher CPAP pressure for all the groups (pâ¯<â¯0.001 for the nasal group, pâ¯=â¯0.001 for the pillow group and pâ¯=â¯0.049 for the oronasal group). Body mass index and residual AHI were correlated with of a higher CPAP pressure for the nasal and pillow groups only (pâ¯<â¯0.001). CONCLUSION: The interface can have a significant impact on the effectiveness of PAP titration. Patients with oronasal masks have higher CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency and higher wake time after sleep onset. Oronasal masks should not be recommended as the first choice for apnea patients. LEVEL OF EVIDENCE: Level 3.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Humanos , Máscaras , Estudos Retrospectivos , Desenho de Equipamento , Apneia Obstrutiva do Sono/terapiaRESUMO
PURPOSE: Nasal masks are usually the first choice for CPAP therapy, but patients may experience side effects. There are limited data regarding the efficacy of nasal pillows masks during CPAP titration. This study aimed to compare the polysomnography outcomes during CPAP titration while comparing two types of masks (nasal and pillows) and to assess whether or not the patient characteristics differed between mask preferences. METHODS: In a sleep-disorders clinic, we prospectively analyzed all patients undergoing CPAP titration for three consecutive months. CPAP pressures were manually titrated. Anthropometric data (age, sex, body mass index, and neck and waist circumferences) and OSA severity were documented. Patients completed a self-administered questionnaire that measured nasal obstruction (NOSE scale). Before titration, both types of masks were presented to patients, and each of them chose the one they preferred. RESULTS: Of 157 patients, 55% (n = 86) used nasal masks, and 45% (n = 71) used nasal pillows masks. There was no difference according to mask type chosen by age, sex, body mass index, neck and waist circumferences, and NOSE scale. Polysomnography outcomes were similar between the mask groups. The mean CPAP level was 9.4 ± 1.8 cm H2O for nasal masks and 9.1 ± 2.0 cm H2O for nasal pillows (p = 0.61). Residual apnea-hypopnea index was 3.0 ± 2.8 events/h for nasal mask and 3.5 ± 4.1 events/h for pillow mask (p = 0.28). Baseline AHI, body mass index, neck and waist circumferences, and residual AHI were independent predictors of a higher CPAP pressure for both groups (p < 0.0001). CONCLUSIONS: Nasal pillows masks seem to be as effective as nasal masks and may be considered to be an initial choice for CPAP titration.