Do patients with chronic sinonasal problems who initiate positive airway pressure (PAP) therapy for OSA demonstrate improved adherence with an oronasal mask versus nasal and nasal pillow interfaces?
The presence of nasal problems does not predict the need for an oronasal mask. Positive pressure adherence rates are higher with nasal and nasal pillow interfaces when compared with oronasal masks, even in patients with sinonasal complaints.
Explore this issue:October 2017
Background: PAP remains the standard first-line therapy for OSA, but its efficacy is limited by suboptimal adherence. Myriad patient and treatment factors affect PAP adherence, many of which are directly or indirectly related to mask interface, and poorer adherence has been previously associated with oronasal masks. Despite this correlation, there is a notion that patients with nasal obstruction may be more likely to succeed using an interface that delivers positive pressure via both the nasal and oral airways. Thus, these patients are often fit by default to oronasal masks during titration and initiation of therapy, without the opportunity to try a smaller and potentially more successful interface. Because the outcomes of PAP therapy are often determined in the first few weeks of treatment, an unfavorable initial mask choice may have adverse long-term consequences.
Study design: Retrospective analysis of medical records and polysomnography data at a tertiary-care, academic center.