University of Oklahoma Health Sciences Center

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Author/s:

Andrade, Rafaela G. S., Viana, Fernanda M., Nascimento, Juliana A., Drager, Luciano F., Moffa, Adriano, Brunoni, André R., Genta, Pedro R., Lorenzi-Filho, Geraldo

Date Added:

November 1, 2018

Journal/Publication:

CHEST

Publisher:

American College of Chest Physicians

Publication Date:

March 1, 2018

Issue:

Volume:

153

Pages:

665-674

URL:

Nasal vs Oronasal CPAP for OSA Treatment: A Meta-Analysis.

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.chest.2017.10.044

PMID (1):

29273515

Keywords

CPAP

OSA

oronasal mask

MeSH

masks

continuous positive airway pressure

sleep apnea syndromes

RPR Commentary

In adults with obstructive sleep apnea, oronasal CPAP requires higher pressures, is less effective for reducing AHI, and is associated with reduced adherence compared with nasal CPAP.

Abstract

BACKGROUND:

Nasal CPAP is the "gold standard" treatment for OSA. However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and nonrandomized trials that compared nasal vs oronasal masks on CPAP level, residual apnea-hypopnea index (AHI), and CPAP adherence to treat OSA.

METHODS:

The Cochrane Central Register of Controlled Trials, Medline, and Web of Science were searched for relevant studies in any language with the following terms: "sleep apnea" and "CPAP" or "sleep apnea" and "oronasal mask" or "OSA" and "oronasal CPAP" or "oronasal mask" and "adherence." Studies on CPAP treatment for OSA were included, based on the following criteria: (1) original article; (2) randomized or nonrandomized trials; and (3) comparison between nasal and oronasal CPAP including pressure level, and/or residual AHI, and/or CPAP adherence.

RESULTS:

We identified five randomized and eight nonrandomized trials (4,563 patients) that reported CPAP level and/or residual AHI and/or CPAP adherence. Overall, the random-effects meta-analysis revealed that as compared with nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g, -0.59; 95% CI, -0.82 to -0.37; P < .001) (on average, +1.5 cm H2O), higher residual AHI (Hedges' g, -0.34; 95% CI, -0.52 to -0.17; P < .001) (+2.8 events/h), and a poorer adherence (Hedges' g, 0.50; 95% CI, 0.21-0.79; P = .001) (-48 min/night).

CONCLUSIONS:

Oronasal masks are associated with a higher CPAP level, higher residual AHI, and poorer adherence than nasal masks.

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