Ebben Matthew R, Narizhnaya Mariya, Segal Alan Z, Barone Daniel, Krieger Ana C
Department of Neurology, Center for Sleep Medicine, Weill Cornell Medical College, 425 East 61st Street, 5th Floor, New York, NY 10065, USA.
Department of Neurology, Center for Sleep Medicine, Weill Cornell Medical College, 425 East 61st Street, 5th Floor, New York, NY 10065, USA; Department of Medicine, Center for Sleep Medicine, Weill Cornell Medical College, 425 East 61st Street, 5th Floor, New York, NY 10065, USA.
Sleep Med. 2014 Jun;15(6):619-24. doi: 10.1016/j.sleep.2014.01.011. Epub 2014 Feb 8.
It has been found that mask style can affect the amount of continuous positive airway pressure (CPAP) required to reduce an apnoea/hyponoea index (AHI) to < 5/h on a titration study. However, it was not previously known whether switching from one CPAP mask style to another post titration could affect the residual AHI with CPAP. The purpose of this study was to investigate the differences in residual AHI with CPAP treatment between oronasal and nasal masks.
Twenty-one subjects (age mean (M)=62.9, body mass index (BMI) M=29.6 kg/m2) were randomised (14 subjects completed the protocol) to undergo an in-laboratory CPAP titration with either a nasal mask or an oronasal mask. Subjects were then assigned this mask for 3weeks of at-home CPAP use with the optimal treatment pressure determined on the laboratory study (CPAP M=8.4 cm of H2O). At the end of this 3-week period, data were collected from the CPAP machine and the subject was given the other mask to use with the same CPAP settings for the next 3weeks at home (if the nasal mask was given initially, the oronasal one was given later and vice versa). On completion of the second 3-week period, data on residual AHI were again collected and compared with the first 3-week period on CPAP.
A Wilcoxon Signed-Rank Test (two-tailed) revealed that residual AHI with CPAP treatment was significantly higher with the oronasal compared with the nasal mask (z = -3.296, p<0.001). All 14 subjects had a higher residual AHI with the oronasal versus nasal mask, and 50% of the subjects had a residual AHI >10/h in the oronasal mask condition, even though all of these subjects were titrated to an AHI of < 5/h in the laboratory.
A higher residual AHI was seen in all patients with the use of an oronasal mask compared with a nasal mask. Switching to an oronasal mask post titration results in an increase in residual AHI with CPAP treatment, and pressure adjustment may be warranted.
在一项滴定研究中发现，面罩类型会影响将呼吸暂停/低通气指数（AHI）降至<5次/小时所需的持续气道正压通气（CPAP）量。然而，此前尚不清楚滴定后从一种CPAP面罩类型更换为另一种面罩是否会影响CPAP治疗后的残余AHI。本研究的目的是调查口鼻面罩和鼻面罩在CPAP治疗下残余AHI的差异。
21名受试者（平均年龄（M）=62.9岁，体重指数（BMI）M=29.6kg/m²）被随机分组（14名受试者完成了实验方案），使用鼻面罩或口鼻面罩在实验室进行CPAP滴定。然后为受试者分配该面罩，让其在家中使用CPAP 3周，使用实验室研究确定的最佳治疗压力（CPAP M=8.4cmH₂O）。在这3周结束时，从CPAP机器收集数据，并在接下来的3周让受试者在家中使用相同的CPAP设置佩戴另一种面罩（如果最初使用的是鼻面罩，则后来使用口鼻面罩，反之亦然）。在第二个3周结束时，再次收集残余AHI的数据，并与CPAP治疗的第一个3周进行比较。
Wilcoxon符号秩检验（双侧）显示，与鼻面罩相比，使用口鼻面罩时CPAP治疗后的残余AHI显著更高（z=-3.296，p<0.001）。所有14名受试者使用口鼻面罩时的残余AHI均高于使用鼻面罩时，并且50%的受试者在使用口鼻面罩时残余AHI>10次/小时，尽管所有这些受试者在实验室中滴定至AHI<5次/小时。
与鼻面罩相比，所有使用口鼻面罩的患者残余AHI更高。滴定后更换为口鼻面罩会导致CPAP治疗的残余AHI增加，可能需要进行压力调整。
