The Importance of Mask Selection on Continuous Positive Airway Pressure Outcomes for Obstructive Sleep Apnea. An Official American Thoracic Society Workshop Report

Pedro R Genta, Marta Kaminska, Bradley A Edwards, Matthew R Ebben, Ana C Krieger, Renaud Tamisier, Lichuan Ye, Terri E Weaver, Olivier M Vanderveken, Geraldo Lorenzi-Filho, Pam DeYoung, William Hevener, Patrick Strollo, Pedro R Genta, Marta Kaminska, Bradley A Edwards, Matthew R Ebben, Ana C Krieger, Renaud Tamisier, Lichuan Ye, Terri E Weaver, Olivier M Vanderveken, Geraldo Lorenzi-Filho, Pam DeYoung, William Hevener, Patrick Strollo

Abstract

Continuous positive airway pressure (CPAP) remains the major treatment option for obstructive sleep apnea (OSA). The American Thoracic Society organized a workshop to discuss the importance of mask selection for OSA treatment with CPAP. In this workshop report, we summarize available evidence about the breathing route during nasal and oronasal CPAP and the importance of nasal symptoms for CPAP outcomes. We explore the mechanisms of air leaks during CPAP treatment and possible alternatives for leak control. The impact of nasal and oronasal CPAP on adherence, residual apnea-hypopnea index, unintentional leaks, and pressure requirements are also compared. Finally, recommendations for patient and partner involvement in mask selection are presented, and future directions to promote personalized mask selection are discussed.

Keywords: continuous positive airway pressure; masks; obstructive sleep apnea.

Figures

Figure 1.
Figure 1.
Potential effect of oronasal continuous positive airway pressure (CPAP) on upper-airway patency. (A) Nasal CPAP splints the upper airway and pushes the soft palate against the tongue. (B) Oronasal CPAP may neutralize the splinting effect of nasal CPAP because of the transmission of positive pressure to the mouth.
Figure 2.
Figure 2.
Different mechanisms of oral leak during nasal continuous positive airway pressure (CPAP). (A) Normal nasal inspiration: observe that the tongue and soft palate are coupled. (B) Expiratory mouth leak: observe that the soft palate prolapses and blocks the nasopharynx, and air leaks through the mouth while it is closed. (a) Airflow characteristics of expiratory mouth leak: a normal breath with symmetric inspiratory (positive) and expiratory (negative) shape is followed by a series of breaths with abrupt termination of expiratory flow. Adapted by permission from Reference . (C) Continuous mouth leak during inspiration and expiration: observe that the mouth is open and that the soft palate–tongue coupling is lost.
Figure 3.
Figure 3.
Mechanisms involved in CPAP unintentional leak. Adapted by permission from Reference . APAP = autoadjusting positive airway pressure; BMI = body mass index; CPAP = continuous positive airway pressure.

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