The Five Z’s – Journal Review – Nasal vs Oro-nasal PAP

Article:  

Transmission of Oral Pressure Compromises Oronasal CPAP Efficacy in the Treatment of OSA

Date of Publication:  Dec 2019

Reference: Madeiro F, Andrade RGS, Piccin VS, Pinheiro GDL, et al. Transmission of Oral Pressure Compromises Oronasal CPAP Efficacy in the Treatment of OSA.  Chest 2019; 156(6):1187-1194

Reason/Problem/Purpose:  The authors point out reports that in general patients on oral/nasal mask do not do as well clinically as patients treated with nasal mask.  In addition those patients require more pressure than do those on nasal mask.

This study was designed to assess the reasons that occurs.

Type of work:  Patients (#13) who were on stable therapy with oral/nasal mask under went PSG with sedation. They had a pressure catheter placed at the level of the epiglottis and pediatric bronchoscopes placed at the velopharynx and oropharynx to evaluate the retro palatal area and retro glossal areas.   The masks they wore were oral/nasal masks with two independent sealed compartments with separate pressure monitoring.  Flow could be directed through one, the other or both.  CPAP titrations were carried out with nasal PAP and oral/nasal PAP.

Observed Results:  More pressure was required to stabilize patients with oral/nasal mask than with nasal alone.  The study suggests that the oral pressure compromises the nasal pressure at the retro-palate level.  Previous work had suggested the oral/nasal mask was pushing the tongue posteriorly.

Comments:  As most clinicians know, less is better most of the time when it comes to mask selection.  The authors suggest always encouraging a trial of a nasal mask for therapy.  

I couldn’t agree more.

RGH