Comparing the Efficacy, Mask Leak, Patient Adherence, and Patient Preference of Three Different CPAP Interfaces to Treat Moderate-Severe Obstructive Sleep Apnea.
STUDY OBJECTIVES
To determine if the type of continuous positive airway pressure (CPAP) mask interface influences CPAP treatment efficacy, adherence, side effects, comfort and sleep quality in patients with moderate-severe obstructive sleep apnea (OSA).


METHODS
This took place in a hospital-based tertiary sleep disorders unit. It is a prospective, randomized, crossover trial comparing three CPAP interfaces: nasal mask (NM), nasal mask plus chinstrap (NM-CS) and oronasal mask (ONM) each tried in random order, for 4 weeks. After each 4-week period, patient outcomes were assessed. Participants had a new diagnosis of obstructive sleep apneas. Forty-eight patients with moderate-severe OSA (32 males, mean ± standard deviation apnea-hypopnea index (AHI) 55.6 ± 21.1 events/h, age 54.9 ± 13.1 years, body mass index 35.8 ± 7.2 kg/m2) were randomized. Thirty-five participants completed the full study, with complete data available for 34 patients.


RESULTS
There was no statistically significant difference in CPAP adherence; however, residual AHI was higher with ONM than NM and NM-CS (residual AHI 7.1 ± 7.7, 4.0 ± 3.1, 4.2 ± 3.7 events/h respectively, main effect P = .001). Patient satisfaction and quality of sleep were higher with the NM and NM-CS than the ONM. Fewer leak and mask fit problems were reported with NM (all chi-square P < .05), which patients preferred over the NM-CS and ONM options (n = 22, 9 and 4 respectively, P = .001).


CONCLUSIONS
The CPAP adherence did not differ between the three different mask interfaces but the residual AHI was lower with NM than ONM and patients reported greater mask comfort, better sleep, and overall preference for a NM. A nasal mask with or without chinstrap should be the first choice for patients with OSA referred for CPAP treatment.


CLINICAL TRIAL REGISTRATION
Registry: Australian and New Zealand Clinical Trials Registry, URL: https://www.anzctr.org.au, title: A comparison of continuous positive airway pressure (CPAP) interface in the control of leak, patient compliance and patient preference: nasal CPAP mask and chinstrap versus full face mask in patients with obstructive sleep apnoea (OSA), identifier: ACTRN12609000029291.
['Rowland|Sharn|S|', 'Aiyappan|Vinod|V|', 'Hennessy|Cathy|C|', 'Catcheside|Peter|P|', 'Chai-Coezter|Ching Li|CL|', 'McEvoy|R Doug|RD|', 'Antic|Nick A|NA|']
D001315:Australia D045422:Continuous Positive Airway Pressure D018592:Cross-Over Studies D004867:Equipment Design D005260:Female D006801:Humans D008297:Male D008397:Masks D008875:Middle Aged D010349:Patient Compliance D057240:Patient Preference D017060:Patient Satisfaction D017286:Polysomnography D011446:Prospective Studies D012720:Severity of Illness Index D020181:Sleep Apnea, Obstructive D016896:Treatment Outcome
adherence sleep apnea continuous positive airways pressure