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Choosing the right mask for your Asian patient with sleep apnoea: A randomized, crossover trial of CPAP interfaces
Author(s) -
Goh Ken Junyang,
Soh Rui Ya,
Leow Leong Chai,
Toh Song Tar,
Song Pei Rong,
Hao Ying,
Lee Ken Cheah Hooi,
Tan Gan Liang,
Ong Thun How
Publication year - 2019
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13396
Subject(s) - medicine , continuous positive airway pressure , crossover study , nose , randomized controlled trial , tolerability , craniofacial , anesthesia , nasal spray , polysomnography , nasal administration , surgery , apnea , obstructive sleep apnea , adverse effect , placebo , alternative medicine , pathology , psychiatry , immunology
Background and objective A major challenge with the treatment of obstructive sleep apnoea (OSA) is adherence to continuous positive airway pressure (CPAP) therapy. Mask tolerability is an important determinant of adherence, however evidence to guide selection of mask interfaces is lacking. Methods We conducted a randomized crossover trial of mask interfaces in CPAP therapy for moderate‐to‐severe OSA to assess adherence and efficacy of CPAP therapy with nasal mask, nasal pillow and oronasal masks. Demographic data, Nasal Obstruction Symptom Evaluation (NOSE) scores and craniofacial measurements were also analysed for associations with adherence with oronasal masks. Results Eighty‐five patients were included in the study (mean ± SD age: 46 ± 12 years; body mass index: 29.9 ± 5.6 kg/m 2 ; apnoea–hypopnoea index (AHI): 53.6 ± 24.0 events/h). Patients had better adherence with nasal masks (average night use: 3.96 ± 2.26 h/night) compared to oronasal masks (3.26 ± 2.18 h/night, P < 0.001) and nasal pillows (3.48 ± 2.20 h/night, P = 0.007). Residual AHI was higher with oronasal masks (7.2 ± 5.2) compared to nasal masks (4.0 ± 4.2, P < 0.001) and nasal pillows (4.1 ± 3.3, P < 0.001). Twenty‐two (25.9%) patients had the best adherence with oronasal masks (4.22 ± 2.14 vs 2.93 ± 2.12 h/night, P = 0.016). These patients had lower NOSE scores (15 (0–35) vs 40 (10–55), P = 0.024) and larger menton‐labrale inferioris/biocular width ratios (31 ± 3% vs 28 ± 4%, P = 0.019). Conclusion Nasal masks are the preferred interface during CPAP initiation. Patients with less nasal obstruction and a proportionally increased chin‐lower lip distance to mid‐face width may have better CPAP adherence with an oronasal mask interface.