• AndradeRafaela G SRGSSleep Laboratory of the Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil., Fernanda M Viana, Juliana A Nascimento, Luciano F Drager, Adriano Moffa, André R Brunoni, Pedro R Genta, and Geraldo Lorenzi-Filho.
• Sleep Laboratory of the Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.
• Chest. 2018 Mar 1; 153 (3): 665-674.

BackgroundNasal 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.MethodsThe 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.ResultsWe 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).ConclusionsOronasal masks are associated with a higher CPAP level, higher residual AHI, and poorer adherence than nasal masks.Trial RegistryPROSPERO database; No.: CRD42017064584; URL: https://www.crd.york.ac.uk/prospero/.Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

11 keywords...

hide…