Jeane Lima de Andrade Xavier, Mariana Delgado Fernandes, Rafaela Garcia Santos de Andrade, Pedro R Genta, Geraldo Lorenzi-Filho
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One study was performed with the nasal and oral compartments opened and the other study was performed with only the oral compartment opened. CPAP titration was carried out in the supine and lateral positions. Finally, the patients were offered a nasal mask. A third polysomnography test was performed using nasal CPAP.</p><p><strong>Results: </strong>Twenty patients with OSA (baseline apnea-hypopnea index [AHI], 52 ± 21 events/h) adapted to oronasal CPAP were studied. Most patients (75%) were oronasal breathers with optimal CPAP. Oral CPAP was less effective to treat OSA than oronasal CPAP, evidenced by a higher residual AHI (median, 2 [interquartile range (IQR), 1-6.0] vs 12.5 [IQR, 1.8-28.3); P = .003), despite a significantly higher CPAP level (median, 10 cm H<sub>2</sub>O [IQR, 9-10 cm H<sub>2</sub>O] vs 11 cm H<sub>2</sub>O [IQR, 10-12 cm H<sub>2</sub>O]; P = .003). The residual AHI was significantly lower in the lateral position for both oronasal and oral CPAP. Finally, patients (75%) agreed to change and preferred to continue using a nasal mask, which resulted in lower CPAP and better OSA control.</p><p><strong>Interpretation: </strong>Our results indicate that the effectiveness of oronasal CPAP to abolish OSA is decreased significantly when patients are required to breathe exclusively through the mouth. Oronasal CPAP efficacy is significantly better in the lateral position. 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引用次数: 0
摘要
背景：口鼻面罩被广泛用于使用 CPAP 治疗 OSA。然而，与鼻用 CPAP 相比，口鼻 CPAP 的有效性和依从性较低：研究问题：口腔途径和侧卧位对适应口鼻 CPAP 的患者有什么影响？研究设计和方法：使用口鼻CPAP的OSA患者按随机顺序接受了2次CPAP多导睡眠图（PSG）滴定，使用的口鼻面罩有2个独立的密封隔间，分别与2个独立的气动测速仪相连。一项研究是在打开鼻腔和口腔隔室的情况下进行的，另一项研究是在仅打开口腔隔室的情况下进行的。CPAP 滴定在仰卧位和侧卧位进行。最后，为患者提供了鼻罩。使用鼻腔 CPAP 进行第三次 PSG：研究了 20 名适应口鼻 CPAP 的 OSA 患者（基线 AHI：52 ± 21 事件/小时）。大多数患者（75%）在使用最佳 CPAP 时都能进行口鼻呼吸。口腔 CPAP 对治疗 OSA 的效果不如口鼻 CPAP，表现为残余 AHI 更高（2 (1 - 6.0) vs 12.5 (1.8 - 28.3); P = 0.003），尽管 CPAP 水平明显更高（10 (9 - 10) vs 11 (10 - 12) cmH20; P = 0.003）。在侧卧位时，口鼻CPAP和口服CPAP的残余AHI都明显较低。最后，患者（75%）同意更换，并倾向于继续使用鼻罩，从而降低了 CPAP，更好地控制了 OSA：解释：当患者需要完全用口呼吸时，口鼻 CPAP 消除 OSA 的效果会明显降低。在侧卧位时，口鼻 CPAP 的效果明显更好。转用鼻罩后，CPAP 治疗 OSA 的效果更高。
Impact of Exclusive Mouth Route and Lateral Position on the Efficacy of Oronasal CPAP to Treat OSA in Patients With OSA Adapted to Oronasal Mask.
Background: Oronasal masks are used widely for treating OSA with CPAP. However, oronasal CPAP is associated with lower effectiveness and lower adherence than nasal CPAP.
Research question: What is the impact of oral route and lateral position in patients well adapted to oronasal CPAP? Can these patients be switched to nasal CPAP?
Study design and methods: Patients with OSA receiving oronasal CPAP underwent two CPAP polysomnography titrations in random order using an oronasal mask with two independent sealed compartments connected to two separate pneumotachographs. One study was performed with the nasal and oral compartments opened and the other study was performed with only the oral compartment opened. CPAP titration was carried out in the supine and lateral positions. Finally, the patients were offered a nasal mask. A third polysomnography test was performed using nasal CPAP.
Results: Twenty patients with OSA (baseline apnea-hypopnea index [AHI], 52 ± 21 events/h) adapted to oronasal CPAP were studied. Most patients (75%) were oronasal breathers with optimal CPAP. Oral CPAP was less effective to treat OSA than oronasal CPAP, evidenced by a higher residual AHI (median, 2 [interquartile range (IQR), 1-6.0] vs 12.5 [IQR, 1.8-28.3); P = .003), despite a significantly higher CPAP level (median, 10 cm H2O [IQR, 9-10 cm H2O] vs 11 cm H2O [IQR, 10-12 cm H2O]; P = .003). The residual AHI was significantly lower in the lateral position for both oronasal and oral CPAP. Finally, patients (75%) agreed to change and preferred to continue using a nasal mask, which resulted in lower CPAP and better OSA control.
Interpretation: Our results indicate that the effectiveness of oronasal CPAP to abolish OSA is decreased significantly when patients are required to breathe exclusively through the mouth. Oronasal CPAP efficacy is significantly better in the lateral position. The transition to nasal mask results in higher CPAP effectiveness to treat OSA.
期刊介绍：
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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