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https://hdl.handle.net/2440/110410
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Type: | Journal article |
Title: | Choosing an oronasal mask to deliver continuous positive airway pressure may cause more upper airway obstruction or lead to higher continuous positive airway pressure requirements than a nasal mask in some patients: a case series |
Author: | Ng, J. Aiyappan, V. Mercer, J. Catcheside, P. Chai-Coetzer, C. McEvoy, R. Antic, N. |
Citation: | The Journal of Clinical Sleep Medicine, 2016; 12(9):1227-1232 |
Publisher: | American Academy of Sleep Medicine |
Issue Date: | 2016 |
ISSN: | 1550-9389 1550-9397 |
Statement of Responsibility: | Justin R. Ng, Vinod Aiyappan, Jeremy Mercer, Peter G. Catcheside, Ching Li Chai-Coetzer, R. Doug McEvoy, Nick Antic |
Abstract: | Study Objectives: The choice of mask interface used with continuous positive airway pressure (CPAP) therapy can affect the control of upper airway obstruction (UAO) in obstructive sleep apnea (OSA). We describe a case series of four patients with paradoxical worsening of UAO with an oronasal mask and the effect of changing to a nasal mask. Methods: We retrospectively reviewed the case histories of 4 patients and recorded patient demographics, in-laboratory and ambulatory CPAP titration data, CPAP therapy data, type of mask interface used and potential confounding factors. Results: The 4 cases (mean ± SD: age = 59 ± 16 y; BMI = 30.5 ± 4.5 kg/m²) had a high residual apnoea-hypopnea index (AHI) (43 ± 14.2 events/h) and high CPAP pressure requirements (14.9 ± 6.6 cmH₂O) with an oronasal mask. Changing to a nasal mask allowed adequate control of UAO with a significant reduction in the average residual AHI (3.1 ± 1.5 events/h). In two of the four cases, it was demonstrated that control of UAO was obtained at a much lower CPAP pressure compared to the oronasal mask (Case one = 17.5 cmH₂O vs 12cmH₂O; Case two = 17.9 cmH₂O vs 7.8 cmH₂O). Other potential confounding factors were unchanged. There are various physiological observations that may explain these findings but it is uncertain which individuals are susceptible to these mechanisms. Conclusions: If patients have OSA incompletely controlled by CPAP with evidence of residual UAO and/or are requiring surprisingly high CPAP pressure to control OSA with an oronasal mask, the choice of mask should be reviewed and consideration be given to a trial of a nasal mask.A commentary on this article appears in this issue on page 1209. |
Keywords: | Nose Oropharynx Humans Sleep Apnea, Obstructive Airway Obstruction Polysomnography Continuous Positive Airway Pressure Retrospective Studies Equipment Design Masks Adult Aged Middle Aged Female Male |
Rights: | Copyright Status Unknown |
DOI: | 10.5664/jcsm.6118 |
Published version: | http://dx.doi.org/10.5664/jcsm.6118 |
Appears in Collections: | Aurora harvest 3 Medicine publications |
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