Mortimore I L, Whittle A T, Douglas N J
Department of Medicine, University of Edinburgh, Royal Infirmary, UK.
Thorax. 1998 Apr;53(4):290-2. doi: 10.1136/thx.53.4.290.
Many patients with sleep apnoea/hypopnoea syndrome (SAHS) find nasal continuous positive airway pressure (CPAP) treatment unsatisfactory due to side effects related to mouth air leakage. A study was performed to compare side effects with face mask and nose mask CPAP therapy in patients with SAHS, with and without uvulopalatopharyngoplasty (U3P).
Twenty newly diagnosed patients with SAHS took part in a randomised double limb trial of face or nose mask CPAP therapy (four weeks per limb) in which CPAP compliance in terms of machine run time was measured and patients answered a symptom questionnaire on side effects resulting from the mask. Ten patients with SAHS with U3P (SAHS/U3P) who were already regular users of nasal CPAP were also given a four week trial of face mask CPAP to compare compliance and symptoms. Ten patients with SAHS were matched with the 10 SAHS/U3P patients for body mass index, age, apnoea/hypopnoea index, and CPAP pressure. Long term compliance was estimated one year after the mask comparison studies.
For patients with SAHS nightly compliance was higher with a nose mask (mean (SE) 5.3 (0.4) hours/night CPAP) than with a face mask (4.3 (0.5) hours/night CPAP), p = 0.01 (mean difference 1.0 hour/night, 95% CI 1.8 to 0.3). Nose masks were rated more comfortable by 19 of 20 patients (p < 0.001) despite more mouth leak related symptoms. For SAHS/U3P patients compliance was marginally higher with nose masks (5.1 (0.7) hours/night CPAP) than with face masks (4.0 (0.8) hours/night CPAP), p = 0.07 (mean difference 1.1 hour/night, 95% CI 2.1 to 0.1). Nose masks were rated more comfortable by seven of 10 patients. There were no significant differences in side effect scores with face and nose masks. At one year nine of 10 SAHS patients and nine of 10 SAHS/U3P patients were still using CPAP. Compliance was 5.4 (0.6) hours/night for the SAHS patients and 3.5 (0.4) hours/night for the SAHS/U3P patients, p = 0.02 (mean difference 1.9 hour/night, 95% CI 3.6 to 0.3).
Compliance is greater with nose mask CPAP than with face mask CPAP because the overall comfort is better and compensates for increased symptoms associated with mouth leakage. Improved face mask design is needed.
许多睡眠呼吸暂停/低通气综合征（SAHS）患者因口漏气相关的副作用而对鼻持续气道正压通气（CPAP）治疗不满意。进行了一项研究，比较SAHS患者使用面罩和鼻罩CPAP治疗的副作用，这些患者接受或未接受悬雍垂腭咽成形术（U3P）。
20名新诊断的SAHS患者参加了一项面罩或鼻罩CPAP治疗的随机双盲试验（每阶段四周），测量了CPAP在机器运行时间方面的依从性，并让患者回答一份关于面罩引起的副作用的症状问卷。10名已长期使用鼻CPAP的SAHS合并U3P患者（SAHS/U3P）也接受了四周的面罩CPAP试验，以比较依从性和症状。将10名SAHS患者与10名SAHS/U3P患者在体重指数、年龄、呼吸暂停/低通气指数和CPAP压力方面进行匹配。在面罩比较研究一年后估计长期依从性。
对于SAHS患者，鼻罩的夜间依从性（平均（标准误）5.3（0.4）小时/晚CPAP）高于面罩（4.3（0.5）小时/晚CPAP），p = 0.01（平均差异1.0小时/晚，95%可信区间1.8至0.3）。尽管有更多与口漏相关的症状，但20名患者中有19名认为鼻罩更舒适（p < 0.001）。对于SAHS/U3P患者，鼻罩的依从性（5.1（0.7）小时/晚CPAP）略高于面罩（4.0（0.8）小时/晚CPAP）中，p = 0.07（平均差异1.1小时/晚，95%可信区间2.1至0.1）。10名患者中有7名认为鼻罩更舒适。面罩和鼻罩的副作用评分无显著差异。一年后，10名SAHS患者中有9名和10名SAHS/U3P患者中有9名仍在使用CPAP。SAHS患者的依从性为5.4（0.6）小时/晚，SAHS/U3P患者为3.5（0.4）小时/晚，p = 0.02（平均差异1.9小时/晚，95%可信区间3.6至0.3）。
鼻罩CPAP的依从性高于面罩CPAP，因为总体舒适度更好，且能弥补与口漏相关的症状增加。需要改进面罩设计。
