Nasal versus oronasal mask in patients under auto-adjusting continuous positive airway pressure titration: a real-life s
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Nasal versus oronasal mask in patients under auto‑adjusting continuous positive airway pressure titration: a real‑life study Ricardo L. M. Duarte1,2 · Bruno A. Mendes3 · Tiago S. Oliveira‑e‑Sá3,4 · Flavio J. Magalhães‑da‑Silveira1 · David Gozal5 Received: 6 July 2020 / Accepted: 22 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Mask type (nasal versus oronasal) can affect the optimal pressure required to correct the apnea/hypopnea index (AHI) in obstructive sleep apnea (OSA) subjects treated with CPAP. Our objective was to evaluate if mask type influenced CPAP titration outcomes in OSA patients. Methods A retrospective study of individuals with a baseline AHI ≥ 15.0/h, who received an auto-adjusting CPAP titrating device (S9 AutoSet ResMed®) in a sleep-lab setting. The mask type oronasal (OM) or nasal (NM) was always selected by the patients. Optimal pressure requirements, leak, and residual AHI were compared based on mask type. Results Overall, 436 patients were included: 283 with NM (64.9%) and 153 with OM (35.1%). At baseline, NM and OM cohorts had similar AHI (p = 0.160). Patients allocated to the OM cohort had a higher 95th percentile pressure, a higher 95th percentile leak, and a higher residual AHI than those with a NM: pressure requirement: 12.9 cm H 2O (IQR: 10.6–15.0) versus 10.7 cm H2O (IQR: 9.2–12.3); leak: 21.6 L/min (IQR: 9.6–37.2) versus 9.6 L/min (IQR: 3.6–19.2); and residual AHI: 4.9/h (IQR: 2.4–10.2) versus 2.2/h (IQR: 1.0–4.4), respectively (p 0.999 0.817
92.4 (91.0–93.4) 79.0 (74.0–83.0)
0.009 0.070
BMI body-mass index, NC neck circumference, ESS Epworth sleepiness scale, AHI apnea/hypopnea index, AI apnea index, HI hypopnea index, SpO2 oxygen saturation Table 2 Optimal CPAP pressure requirements, leak, and residual events according to mask choice during titration Parameter
Nasal mask cohort (n = 283)
Pressure, cm H2O 50th percentile 7.5 (6.2–9.1) 95th percentile 10.7 (9.2–12.3) Maximum 12.2 (10.4–14.5) Leak, l/min 50th percentile 0.0 (0.0–4.8) 95th percentile 9.6 (3.6–19.2) Maximum 19.2 (10.8–36.0) Residual events, n/h AHI, n/h 2.2 (1.0–4.4) AI, n/h 1.8 (0.8–3.8) HI, n/h 0.2 (0.0–0.6)
Oronasal mask cohort (n = 153)
p value
8.7 (7.1–10.5) 12.9 (10.6–15.0) 14.9 (12.4–15.9)
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