title: Type of mask may impact on continuous positive airway pressure adherence in apneic patients.
abstract: BACKGROUND
  In obstructive sleep apnea patients (OSA), continuous positive airway pressure (CPAP) adherence is crucial to improve symptoms and cardiometabolic outcomes. The choice of mask may influence CPAP adherence but this issue has never been addressed properly.
  
  
  OBJECTIVE
  To evaluate the impact of nasal pillows, nasal and oronasal masks on CPAP adherence in a cohort of OSA.
  
  
  METHODS
  Newly CPAP treated OSA participating in "Observatoire Sommeil de la Fédération de Pneumologie", a French national prospective cohort, were included between March 2009 and December 2011. Anthropometric data, medical history, OSA severity, sleepiness, depressive status, treatment modalities (auto-CPAP versus fixed pressure, pressure level, interface type, use of humidifiers) and CPAP-related side effects were included in multivariate analysis to determine independent variables associated with CPAP adherence.
  
  
  RESULTS
  2311 OSA (age = 57(12) years, apnea+hypopnea index = 41(21)/h, 29% female) were included. Nasal masks, oronasal masks and nasal pillows were used by 62.4, 26.2 and 11.4% of the patients, respectively. In univariate analysis, oronasal masks and nasal pillows were associated with higher risk of CPAP non-adherence. CPAP non-adherence was also associated with younger age, female gender, mild OSA, gastroesophageal reflux, depression status, low effective pressure and CPAP-related side effects. In multivariate analysis, CPAP non-adherence was associated with the use of oronasal masks (OR = 2.0; 95%CI = 1.6; 2.5), depression, low effective pressure, and side effects.
  
  
  CONCLUSIONS
  As oronasal masks negatively impact on CPAP adherence, a nasal mask should be preferred as the first option. Patients on oronasal masks should be carefully followed.
authors.affiliation: Research and Development department, AGIRadom, Meylan, France. j.borel@agiradom.com
authors.forename: Jean Christian
authors.initials: JC
authors.lastname: Borel
authors.forename: Renaud
authors.initials: R
authors.lastname: Tamisier
authors.forename: Sonia
authors.initials: S
authors.lastname: Dias-Domingos
authors.forename: Marc
authors.initials: M
authors.lastname: Sapene
authors.forename: Francis
authors.initials: F
authors.lastname: Martin
authors.forename: Bruno
authors.initials: B
authors.lastname: Stach
authors.forename: Yves
authors.initials: Y
authors.lastname: Grillet
authors.forename: Jean François
authors.initials: JF
authors.lastname: Muir
authors.forename: Patrick
authors.initials: P
authors.lastname: Levy
authors.forename: Frederic
authors.initials: F
authors.lastname: Series
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pepin
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008397:Masks; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*