Oronasal mask may compromise the efficacy of continuous positive airway pressure on OSA treatment: is there evidence for avoiding the oronasal route?
Continuous positive airway pressure (CPAP) delivered by nasal mask is the gold standard treatment for obstructive sleep apnea (OSA). However, oral and oronasal masks are also available. We considered experimental evidence and reviewed clinical trials that evaluated the impact of oral and oronasal mask on OSA treatment.



One recent study in 18 OSA patients that slept with a customized oronasal mask with two sealed compartments showed that the change of CPAP flow from nasal to oronasal and oral caused upper airway obstruction because of posterior displacement of the tongue demonstrated by nasoendoscopy. Oral masks use a mouthpiece that may stabilize the jaw and the tongue and have shown to be effective. However, oral masks are not widely used in clinical practice. Four out of five observational studies and all five reviewed randomized studies showed a worse performance of oronasal when compared with nasal masks. Oronasal masks were associated with higher residual apnea-hypopnea index, lower adherence, more leaks, and less satisfaction than nasal mask in the majority of the studies.



Nasal CPAP must be the first choice to treat OSA. Patients on oronasal mask should be carefully followed. VIDEO ABSTRACT.
Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil.
Rafaela Garcia Santos
RG
Andrade
Fernanda
F
Madeiro
Pedro Rodrigues
PR
Genta
Geraldo
G
Lorenzi-Filho
D045422:Continuous Positive Airway Pressure; D006801:Humans; D008297:Male; D008397:Masks; D009666:Nose; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*