Matsumura Erika, Grad Gustavo F, Madeiro Fernanda, Genta Pedro R, Lorenzi-Filho Geraldo
Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Ann Am Thorac Soc. 2025 Mar;22(3):430-437. doi: 10.1513/AnnalsATS.202404-425OC.
Mouth air leak is a major cause of low adherence to nasal continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA). However, CPAP reports do not distinguish mouth leak from mask leak. We hypothesized that mouth air leak is terminated abruptly by an arousal from sleep and mouth closing that can be detected by CPAP leak waveform analysis. To describe patterns of mouth air leak waveform during polysomnography (PSG) in patients with OSA treated with well-fitted nasal CPAP. PSG recordings with a jaw motion sensor to detect mouth opening were performed in patients with OSA treated with nasal CPAP with suspected mouth air leak. Careful mask fitting and visual inspection excluded mask leak. Mouth leak episodes were characterized by an increase (⩾20%) above the intentional leak. Leak episodes were classified as intermittent (<5 minutes) or continuous (⩾5 minutes). Twenty patients (80% men; age, 63 ± 11 years; body mass index, 29.9 ± 6 kg/m; baseline apnea-hypopnea index, 46.9 ± 19 events per hour) treated with nasal CPAP and documented mouth leak completed the study. All but one patient experienced an overlap of intermittent and continuous mouth leak. Most mouth leak episodes ended with mouth closure (97.7%) and an arousal (52.7%) or awakening (38.6%). Only 34.9% of the leak episodes were associated with respiratory events. Intermittent mouth air leak was more common in sleep stages N1 and N2 ( < 0.01), whereas continuous leak was more common in sleep stage N3 ( < 0.01). Continuous episodes of air leak were associated with a higher amplitude of mouth opening. The CPAP report waveform was able to detect only 29.6% of the leak episodes detected by PSG. Only 10 patients (50%) had a high unintentional leak according to the criteria adopted by ResMed, and only 2 patients (10%) presented large leak according to the Philips criteria. Intermittent and continuous mouth leak during nasal CPAP frequently coexist and contribute to sleep fragmentation. Identification of leak waveform patterns may help detect mouth air leak, which, in turn, is an important cause of poor CPAP adherence.
口漏气是阻塞性睡眠呼吸暂停（OSA）患者鼻持续气道正压通气（CPAP）依从性低的主要原因。然而，CPAP报告并未区分口漏气和面罩漏气。我们推测，睡眠中的觉醒和闭嘴会突然终止口漏气，这可以通过CPAP漏气波形分析检测到。描述接受合适鼻CPAP治疗的OSA患者在多导睡眠图（PSG）期间口漏气波形的模式。对怀疑存在口漏气且接受鼻CPAP治疗的OSA患者进行带有下颌运动传感器以检测张口的PSG记录。仔细调整面罩并进行目视检查以排除面罩漏气。口漏气发作的特征是高于故意漏气水平（⩾20%）。漏气发作分为间歇性（<5分钟）或持续性（⩾5分钟）。20例接受鼻CPAP治疗且记录有口漏气的患者（80%为男性；年龄63±11岁；体重指数29.9±6kg/m²；基线呼吸暂停低通气指数46.9±19次/小时）完成了研究。除1例患者外，所有患者都经历了间歇性和持续性口漏气的重叠。大多数口漏气发作以闭嘴（97.7%）以及觉醒（52.7%）或唤醒（38.6%）结束。只有34.9%的漏气发作与呼吸事件相关。间歇性口漏气在N1和N2睡眠阶段更为常见（<0.01），而持续性漏气在N3睡眠阶段更为常见（<0.01）。持续性漏气发作与更大的张口幅度相关。CPAP报告波形仅能检测到PSG检测到的29.6%的漏气发作。根据瑞思迈采用的标准，只有10例患者（50%）存在高无意漏气，根据飞利浦标准只有2例患者（10%）存在大量漏气。鼻CPAP治疗期间的间歇性和持续性口漏气经常共存并导致睡眠片段化。识别漏气波形模式可能有助于检测口漏气，而口漏气又是CPAP依从性差的一个重要原因。
