Skip to main content
Erschienen in: Sleep and Breathing 3/2017

29.03.2017 | Sleep Breathing Physiology and Disorders • Review

Choosing the right interface for positive airway pressure therapy in patients with obstructive sleep apnea

verfasst von: Ahmed S. BaHammam, Tripat Singh, Smitha George, Karen Lorraine Acosta, Kashmira Barataman, Divinagracia E. Gacuan

Erschienen in: Sleep and Breathing | Ausgabe 3/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Positive airway pressure (PAP) is the standard and most effective treatment for obstructive sleep apnea (OSA). It provides a continuous stream of air under positive pressure through the nose, mouth, or both, which prevents collapse of the upper airway. This allows the patient to breathe freely during sleep. The success of PAP therapy depends largely on the selection of the proper interface (mask). The choice and application of the interface in patients with OSA is a great challenge that greatly affects the long-term compliance to PAP therapy.

Methods

This article discusses the different types of masks that can be used in patients with OSA, including the differences between nasal, oro-nasal, and total face masks, breathing during wakefulness and sleep, and the impact of interface type on upper airway patency and mask fitting. We also discuss the steps to be considered in choosing the proper interface and potential problems that may arise during long-term use.

Results and conclusion

Current evidence suggests that the nasal mask is better tolerated, requires lower pressure to eliminate obstructive respiratory events, and is associated with a better sleep quality and better PAP therapy compliance. Nevertheless, the best mask is the one that patient will wear.
Literatur
1.
Zurück zum Zitat Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1(8225):862–865CrossRefPubMed Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1(8225):862–865CrossRefPubMed
2.
Zurück zum Zitat Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine : JCSM: official publication of the American Academy of Sleep Medicine 5(3):263–276 Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of clinical sleep medicine : JCSM: official publication of the American Academy of Sleep Medicine 5(3):263–276
3.
Zurück zum Zitat Kakkar RK, Berry RB (2007) Positive airway pressure treatment for obstructive sleep apnea. Chest 132(3):1057–1072CrossRefPubMed Kakkar RK, Berry RB (2007) Positive airway pressure treatment for obstructive sleep apnea. Chest 132(3):1057–1072CrossRefPubMed
4.
Zurück zum Zitat Beecroft J, Zanon S, Lukic D, Hanly P (2003) Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest 124(6):2200–2208CrossRefPubMed Beecroft J, Zanon S, Lukic D, Hanly P (2003) Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest 124(6):2200–2208CrossRefPubMed
5.
Zurück zum Zitat Gleeson K, Zwillich CW, Braier K, White DP (1986) Breathing route during sleep. Am Rev Respir Dis 134(1):115–120PubMed Gleeson K, Zwillich CW, Braier K, White DP (1986) Breathing route during sleep. Am Rev Respir Dis 134(1):115–120PubMed
6.
7.
Zurück zum Zitat Schwartz AR, Smith PL, Wise RA, Gold AR, Permutt S (1985) Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure. J Appl Physiol 64(2):535–542 Schwartz AR, Smith PL, Wise RA, Gold AR, Permutt S (1985) Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure. J Appl Physiol 64(2):535–542
8.
Zurück zum Zitat Ayappa I, Rapoport DM (2003) The upper airway in sleep: physiology of the pharynx. Sleep Med Rev 7(1):9–33CrossRefPubMed Ayappa I, Rapoport DM (2003) The upper airway in sleep: physiology of the pharynx. Sleep Med Rev 7(1):9–33CrossRefPubMed
9.
Zurück zum Zitat Pevernagie DA, De Meyer MM, Claeys S (2005) Sleep, breathing and the nose. Sleep Med Rev 9(6):437–451CrossRefPubMed Pevernagie DA, De Meyer MM, Claeys S (2005) Sleep, breathing and the nose. Sleep Med Rev 9(6):437–451CrossRefPubMed
10.
Zurück zum Zitat Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS (2003) Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 22(5):827–832CrossRefPubMed Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS (2003) Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J 22(5):827–832CrossRefPubMed
11.
Zurück zum Zitat Miyamoto K, Ozbek MM, Lowe AA, Sjoholm TT, Love LL, Fleetham JA, Ryan CF (1999) Mandibular posture during sleep in patients with obstructive sleep apnoea. Arch Oral Biol 44(8):657–664CrossRefPubMed Miyamoto K, Ozbek MM, Lowe AA, Sjoholm TT, Love LL, Fleetham JA, Ryan CF (1999) Mandibular posture during sleep in patients with obstructive sleep apnoea. Arch Oral Biol 44(8):657–664CrossRefPubMed
12.
Zurück zum Zitat Meurice JC, Marc I, Carrier G, Series F (1996) Effects of mouth opening on upper airway collapsibility in normal sleeping subjects. Am J Respir Crit Care Med 153(1):255–259CrossRefPubMed Meurice JC, Marc I, Carrier G, Series F (1996) Effects of mouth opening on upper airway collapsibility in normal sleeping subjects. Am J Respir Crit Care Med 153(1):255–259CrossRefPubMed
13.
Zurück zum Zitat Fitzpatrick MF, Driver HS, Chatha N, Voduc N, Girard AM (1985) Partitioning of inhaled ventilation between the nasal and oral routes during sleep in normal subjects. J Appl Physiol 94(3):883–890CrossRef Fitzpatrick MF, Driver HS, Chatha N, Voduc N, Girard AM (1985) Partitioning of inhaled ventilation between the nasal and oral routes during sleep in normal subjects. J Appl Physiol 94(3):883–890CrossRef
14.
Zurück zum Zitat Van de Graaff WB (1988) Thoracic influence on upper airway patency. J Appl Physiol (1985) 65(5):2124–2131 Van de Graaff WB (1988) Thoracic influence on upper airway patency. J Appl Physiol (1985) 65(5):2124–2131
15.
Zurück zum Zitat Bachour A, Maasilta P (2004) Mouth breathing compromises adherence to nasal continuous positive airway pressure therapy. Chest 126(4):1248–1254CrossRefPubMed Bachour A, Maasilta P (2004) Mouth breathing compromises adherence to nasal continuous positive airway pressure therapy. Chest 126(4):1248–1254CrossRefPubMed
16.
Zurück zum Zitat Ruhle KH, Nilius G (2008) Mouth breathing in obstructive sleep apnea prior to and during nasal continuous positive airway pressure. Respiration; international review of thoracic diseases 76(1):40–45CrossRefPubMed Ruhle KH, Nilius G (2008) Mouth breathing in obstructive sleep apnea prior to and during nasal continuous positive airway pressure. Respiration; international review of thoracic diseases 76(1):40–45CrossRefPubMed
17.
Zurück zum Zitat Jefferson Y (2010) Mouth breathing: adverse effects on facial growth, health, academics, and behavior. Gen Dent 58(1):18–25 quiz 26-17, 79-80PubMed Jefferson Y (2010) Mouth breathing: adverse effects on facial growth, health, academics, and behavior. Gen Dent 58(1):18–25 quiz 26-17, 79-80PubMed
18.
Zurück zum Zitat Andrade RG, Piccin VS, Nascimento JA, Viana FM, Genta PR, Lorenzi-Filho G (2014) Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea. Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 40(6):658–668CrossRef Andrade RG, Piccin VS, Nascimento JA, Viana FM, Genta PR, Lorenzi-Filho G (2014) Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea. Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 40(6):658–668CrossRef
19.
Zurück zum Zitat Andrade RG, Madeiro F, Piccin VS, Moriya HT, Schorr F, Sardinha PS, Gregorio GM, Genta PR, Lorenzi-Filho G (2016) Impact of acute changes in CPAP flow route in sleep apnea treatment. Chest Andrade RG, Madeiro F, Piccin VS, Moriya HT, Schorr F, Sardinha PS, Gregorio GM, Genta PR, Lorenzi-Filho G (2016) Impact of acute changes in CPAP flow route in sleep apnea treatment. Chest
20.
Zurück zum Zitat Smith PL, Wise RA, Gold AR, Schwartz AR, Permutt S (1985) Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 64(2):789–795 Smith PL, Wise RA, Gold AR, Schwartz AR, Permutt S (1985) Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 64(2):789–795
21.
Zurück zum Zitat Nascimento JA, de Santana CT, Moriya HT, Fernandes PH, de Andrade RG, Genta PR, Lorenzi-Filho G, Nakagawa NK (2016) Body position may influence oronasal CPAP effectiveness to treat OSA. J Clin Sleep Med 12(3):447–448CrossRefPubMedPubMedCentral Nascimento JA, de Santana CT, Moriya HT, Fernandes PH, de Andrade RG, Genta PR, Lorenzi-Filho G, Nakagawa NK (2016) Body position may influence oronasal CPAP effectiveness to treat OSA. J Clin Sleep Med 12(3):447–448CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Massie CA, Hart RW (2003) Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest 123(4):1112–1118CrossRefPubMed Massie CA, Hart RW (2003) Clinical outcomes related to interface type in patients with obstructive sleep apnea/hypopnea syndrome who are using continuous positive airway pressure. Chest 123(4):1112–1118CrossRefPubMed
23.
Zurück zum Zitat Zhu X, Wimms AJ, Benjafield AV (2013) Assessment of the performance of nasal pillows at high CPAP pressures. J Clin Sleep Med 9(9):873–877PubMedPubMedCentral Zhu X, Wimms AJ, Benjafield AV (2013) Assessment of the performance of nasal pillows at high CPAP pressures. J Clin Sleep Med 9(9):873–877PubMedPubMedCentral
24.
Zurück zum Zitat Ryan S, Garvey JF, Swan V, Behan R, McNicholas WT (2011) Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy. J Sleep Res 20(2):367–373CrossRefPubMed Ryan S, Garvey JF, Swan V, Behan R, McNicholas WT (2011) Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy. J Sleep Res 20(2):367–373CrossRefPubMed
25.
Zurück zum Zitat Ebben MR, Oyegbile T, Pollak CP (2012) The efficacy of three different mask styles on a PAP titration night. Sleep Med 13(6):645–649CrossRefPubMed Ebben MR, Oyegbile T, Pollak CP (2012) The efficacy of three different mask styles on a PAP titration night. Sleep Med 13(6):645–649CrossRefPubMed
26.
Zurück zum Zitat Ebben MR, Narizhnaya M, Segal AZ, Barone D, Krieger AC (2014) A randomised controlled trial on the effect of mask choice on residual respiratory events with continuous positive airway pressure treatment. Sleep Med 15(6):619–624CrossRefPubMed Ebben MR, Narizhnaya M, Segal AZ, Barone D, Krieger AC (2014) A randomised controlled trial on the effect of mask choice on residual respiratory events with continuous positive airway pressure treatment. Sleep Med 15(6):619–624CrossRefPubMed
27.
Zurück zum Zitat Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B, Grillet Y, Muir JF, Levy P, Series F, Pepin JL, Scientific Council of The Sleep Registry of the French Federation of (2013) Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One 8(5):e64382CrossRefPubMedPubMedCentral Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B, Grillet Y, Muir JF, Levy P, Series F, Pepin JL, Scientific Council of The Sleep Registry of the French Federation of (2013) Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One 8(5):e64382CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Westhoff M, Litterst P (2015) Obstructive sleep apnoea and non-restorative sleep induced by the interface. Sleep & breathing = Schlaf & Atmung 19(4):1317–1325CrossRef Westhoff M, Litterst P (2015) Obstructive sleep apnoea and non-restorative sleep induced by the interface. Sleep & breathing = Schlaf & Atmung 19(4):1317–1325CrossRef
30.
Zurück zum Zitat Schorr F, Genta PR, Gregorio MG, Danzi-Soares NJ, Lorenzi-Filho G (2012) Continuous positive airway pressure delivered by oronasal mask may not be effective for obstructive sleep apnoea. Eur Respir J 40(2):503–505CrossRefPubMed Schorr F, Genta PR, Gregorio MG, Danzi-Soares NJ, Lorenzi-Filho G (2012) Continuous positive airway pressure delivered by oronasal mask may not be effective for obstructive sleep apnoea. Eur Respir J 40(2):503–505CrossRefPubMed
31.
Zurück zum Zitat Smith PL, O’Donnell CP, Allan L, Schwartz AR (2003) A physiologic comparison of nasal and oral positive airway pressure. Chest 123(3):689–694CrossRefPubMed Smith PL, O’Donnell CP, Allan L, Schwartz AR (2003) A physiologic comparison of nasal and oral positive airway pressure. Chest 123(3):689–694CrossRefPubMed
32.
Zurück zum Zitat Anderson FE, Kingshott RN, Taylor DR, Jones DR, Kline LR, Whyte KF (2003) A randomized crossover efficacy trial of oral CPAP (Oracle) compared with nasal CPAP in the management of obstructive sleep apnea. Sleep 26(6):721–726PubMed Anderson FE, Kingshott RN, Taylor DR, Jones DR, Kline LR, Whyte KF (2003) A randomized crossover efficacy trial of oral CPAP (Oracle) compared with nasal CPAP in the management of obstructive sleep apnea. Sleep 26(6):721–726PubMed
33.
Zurück zum Zitat Khanna R, Kline LR (2003) A prospective 8 week trial of nasal interfaces vs. a novel oral interface (Oracle) for treatment of obstructive sleep apnea hypopnea syndrome. Sleep Med 4(4):333–338CrossRefPubMed Khanna R, Kline LR (2003) A prospective 8 week trial of nasal interfaces vs. a novel oral interface (Oracle) for treatment of obstructive sleep apnea hypopnea syndrome. Sleep Med 4(4):333–338CrossRefPubMed
34.
Zurück zum Zitat Knowles SR, O’Brien DT, Zhang S, Devara A, Rowley JA (2014) Effect of addition of chin strap on PAP compliance, nightly duration of use, and other factors. J Clin Sleep Med 10(4):377–383PubMedPubMedCentral Knowles SR, O’Brien DT, Zhang S, Devara A, Rowley JA (2014) Effect of addition of chin strap on PAP compliance, nightly duration of use, and other factors. J Clin Sleep Med 10(4):377–383PubMedPubMedCentral
35.
Zurück zum Zitat Bhat S, Gushway-Henry N, Polos PG, DeBari VA, Riar S, Gupta D, Lysenko L, Patel D, Pi J, Chokroverty S (2014) The efficacy of a chinstrap in treating sleep disordered breathing and snoring. J Clin Sleep Med 10(8):887–892PubMedPubMedCentral Bhat S, Gushway-Henry N, Polos PG, DeBari VA, Riar S, Gupta D, Lysenko L, Patel D, Pi J, Chokroverty S (2014) The efficacy of a chinstrap in treating sleep disordered breathing and snoring. J Clin Sleep Med 10(8):887–892PubMedPubMedCentral
36.
Zurück zum Zitat Brill A-K (2014) How to avoid interface problems in acute noninvasive ventilation. Breathe 10:231–242CrossRef Brill A-K (2014) How to avoid interface problems in acute noninvasive ventilation. Breathe 10:231–242CrossRef
37.
Zurück zum Zitat Meduri GU, Abou-Shala N, Fox RC, Jones CB, Leeper KV, Wunderink RG (1991) Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 100(2):445–454CrossRefPubMed Meduri GU, Abou-Shala N, Fox RC, Jones CB, Leeper KV, Wunderink RG (1991) Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest 100(2):445–454CrossRefPubMed
Metadaten
Titel
Choosing the right interface for positive airway pressure therapy in patients with obstructive sleep apnea
verfasst von
Ahmed S. BaHammam
Tripat Singh
Smitha George
Karen Lorraine Acosta
Kashmira Barataman
Divinagracia E. Gacuan
Publikationsdatum
29.03.2017
Verlag
Springer International Publishing
Erschienen in
Sleep and Breathing / Ausgabe 3/2017
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-017-1490-9

Weitere Artikel der Ausgabe 3/2017

Sleep and Breathing 3/2017 Zur Ausgabe

Sleep Breathing Physiology and Disorders • Original Article

The effect of acute aerobic exercise on hemostasis in obstructive sleep apnea

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.