Effects of different masks on diaphragm motion in OSAS patients undergoing CPAP: results from an ultrasound-based proof of concept study.

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY

Sleep and Breathing Pub Date : 2024-09-09 DOI:10.1007/s11325-024-03155-5

Sonia Zotti, Simone Scarlata, Anna Annunziata, Lidia Atripaldi, Rosa Cauteruccio, Valentina Di Spirito, Claudio Pedone, Raffaele Antonelli-Incalzi, Giuseppe Fiorentino

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引用次数: 0

Abstract

Purpose: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway narrowing or collapse during sleep. Continuous positive airway pressure (CPAP) remains the preferred treatment in selected patients and masks' choice plays an important role for subsequent respiratory events' reduction. It is known that oronasal masks are not as effective at opening the upper airway compared to nasal ones. Thus, the objective of this study was to investigate differences in US-assessed diaphragmatic excursion (DE) using oronasal vs. nasal CPAP masks.

Methods: This observational study included 50 OSA patients presenting a moderate to severe apnea-hypopnea index and requiring CPAP treatment. All participants received US evaluations on diaphragm motion during their oronasal and nasal CPAP trial at equal positive end-expiratory pressure level.

Results: The difference of DE switching mask during CPAP was assessed by using the non-parametric Wilcoxon signed-rank test. A statistically significant increase in US- assessed DE was found when shifting from oronasal to nasal mask (p-value < 0.01). Linear regression models revealed that increased neck circumference and more severe AHI were associated with decreased DE when shifting to an oronasal mask.

Conclusion: This study evaluated the acute impact on US-assessed DE after changing CPAP route from oronasal to nasal mask. Our results suggest that the nasal type should be the more suitable option for most patients with OSA, especially those with higher nasal circumference. Diaphragmatic motion throughout US may become a practical tool to help in the choice of the fittest mask in patients undergoing CPAP.

Abstract Image

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不同面罩对使用 CPAP 的 OSAS 患者横膈膜运动的影响：基于超声波的概念验证研究结果。

目的：阻塞性睡眠呼吸暂停（OSA）的特点是睡眠时上气道反复狭窄或塌陷。持续气道正压（CPAP）仍是特定患者的首选治疗方法，而面罩的选择对减少后续呼吸事件起着重要作用。众所周知，口鼻面罩在打开上气道方面的效果不如鼻罩。因此，本研究的目的是调查使用口鼻CPAP面罩与鼻腔CPAP面罩时美国评估的横膈膜偏移（DE）的差异：这项观察性研究包括 50 名中度至重度呼吸暂停-低通气指数并需要 CPAP 治疗的 OSA 患者。所有参与者在相同呼气末正压水平下试用口鼻CPAP时都接受了横膈膜运动的US评估：使用非参数 Wilcoxon 符号秩检验评估了 CPAP 期间切换面罩时横膈膜运动的差异。从口鼻面罩转换到鼻面罩时，US 评估的 DE 值有明显增加（p 值结论：该研究评估了 CPAP 对呼吸机的急性影响：本研究评估了将 CPAP 使用途径从口鼻罩改为鼻罩后对 US 评估的 DE 的急性影响。我们的结果表明，对于大多数 OSA 患者，尤其是鼻围较大的患者来说，鼻罩应该是更合适的选择。在使用 CPAP 的患者中，横膈膜在整个 US 过程中的运动可能会成为帮助他们选择最合适面罩的实用工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.