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Original Research: Sleep Disorders |

Impact of Acute Changes in CPAP Flow Route in Sleep Apnea Treatment

Rafaela G.S. Andrade, PhD; Fernanda Madeiro, MD; Vivien S. Piccin, PhD; Henrique T. Moriya, PhD; Fabiola Schorr, MD, PhD; Priscila S. Sardinha, MD; Marcelo G. Gregório, MD, PhD; Pedro R. Genta, MD, PhD; Geraldo Lorenzi-Filho, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: This work was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

aSleep Laboratory, Pulmonary Division, Heart Institute, University of São Paulo, São Paulo, Brazil

bBiomedical Engineering Laboratory of Escola Politécnica, University of São Paulo, São Paulo, Brazil

CORRESPONDENCE TO: Geraldo Lorenzi-Filho, MD, PhD, Sleep Laboratory, Pulmonary Division, Heart Institute, Av. Enéas Carvalho de Aguiar 44, São Paulo, Brazil


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1194-1201. doi:10.1016/j.chest.2016.04.017
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Background  CPAP is the gold standard treatment for OSA and was conceived to be applied through a nasal interface. This study was designed to determine the acute effects of changing the nasal CPAP route to oronasal and oral in upper airway patency during sleep in patients with OSA. We hypothesized that the oronasal route may compromise CPAP’s effectiveness in treating OSA.

Methods  Eighteen patients (mean ± SD age, 44 ± 9 years; BMI, 33.8 ± 4.7 kg/m2; apnea-hypopnea index, 49.0 ± 39.1 events/hour) slept with a customized oronasal mask with nasal and oral sealed compartments connected to a multidirectional valve. Sleep was monitored by using full polysomnography and induced by low doses of midazolam. Nasal CPAP was titrated up to holding pressure. Flow route was acutely changed to the oronasal (n = 18) and oral route (n = 16) during sleep. Retroglossal area was continuously observed by using nasoendoscopy.

Results  Nasal CPAP (14.8 ± 4.1 cm H2O) was able to stabilize breathing in all patients. In contrast, CPAP delivered by the oronasal and oral routes promoted obstructive events in 12 (66.7%) and 14 (87.5%) patients, respectively. Compared with stable breathing during the nasal route, there was a significant and progressive reduction in the distance between the epiglottis and tongue base and the retroglossal area when CPAP was delivered by the oronasal and oral routes.

Conclusions  CPAP delivered through the oronasal route may compromise CPAP’s effectiveness in treating OSA.

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