• Jeane Lima de Andrade Xavier, Mariana Delgado Fernandes, AndradeRafaela Garcia Santos deRGSLaboratorio do Sono, Divisão de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil., Pedro R Genta, and Geraldo Lorenzi-Filho.
• Laboratorio do Sono, Divisão de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
• Chest. 2024 Oct 24.

BackgroundOronasal masks are used widely for treating OSA with CPAP. However, oronasal CPAP is associated with lower effectiveness and lower adherence than nasal CPAP.Research QuestionWhat is the impact of oral route and lateral position in patients well adapted to oronasal CPAP? Can these patients be switched to nasal CPAP?Study Design And MethodsPatients with OSA receiving oronasal CPAP underwent 2 CPAP polysomnography titrations in random order using an oronasal mask with 2 independent sealed compartments connected to 2 separate pneumotachographs. One study was performed with the nasal and oral compartments opened and the other study was performed with only the oral compartment opened. CPAP titration was carried out in the supine and lateral positions. Finally, the patients were offered a nasal mask. A third polysomnography test was performed using nasal CPAP.ResultsTwenty patients with OSA (baseline apnea-hypopnea index [AHI], 52 ± 21 events/h) adapted to oronasal CPAP were studied. Most patients (75%) were oronasal breathers with optimal CPAP. Oral CPAP was less effective to treat OSA than oronasal CPAP, evidenced by a higher residual AHI (median, 2 [interquartile range (IQR), 1-6.0] vs 12.5 [IQR, 1.8-28.3); P = .003), despite a significantly higher CPAP level (median, 10 cm H2O [IQR, 9-10 cm H2O] vs 11 cm H2O [IQR, 10-12 cm H2O]; P = .003). The residual AHI was significantly lower in the lateral position for both oronasal and oral CPAP. Finally, patients (75%) agreed to change and preferred to continue using a nasal mask, which resulted in lower CPAP and better OSA control.InterpretationThe effectiveness of oronasal CPAP to abolish OSA is decreased significantly when patients are required to breathe exclusively through the mouth. Oronasal CPAP efficacy is significantly better in the lateral position. The transition to nasal mask results in higher CPAP effectiveness to treat OSA.Clinical Trial RegistryClinicalTrials.gov; No.: NCT05272761; URL: www.Clinicaltrialsgov.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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