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Contemporary Reviews in Sleep Medicine |

Factors Contributing to Unintentional Leak During CPAP Treatment: A Systematic Review

Marius Lebret, PT, MSc; Jean-Benoit Martinot, MD, PhD; Nathalie Arnol, MSc; Daniel Zerillo, PT, MSc; Renaud Tamisier, MD, PhD; Jean-Louis Pepin, MD, PhD; Jean-Christian Borel, PT, PhD
Author and Funding Information

FUNDING/SUPPORT: The study was funded by AGIRadom, a French nonprofit home care provider.

Drs Pepin and Borel are co-senior authors.

aDepartment of Research and Development, Association AGIR à dom, HP2 Laboratory, INSERM U 1042, Meylan, France

bCHU UCL, Site Sainte Elisabeth, Namur, Belgium

cThorax and Vessels Division, Sleep Laboratory, Grenoble Alpes University, HP2 Laboratory, INSERM U 1042, Grenoble, France

CORRESPONDENCE TO: Marius Lebret, PT, MSc, Agir à dom, 36 Chemin du Vieux Chêne, 38244 Meylan, France


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


Chest. 2017;151(3):707-719. doi:10.1016/j.chest.2016.11.049
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CPAP is the first-line treatment for moderate to severe OSA syndrome. Up to 25% of patients with OSA syndrome discontinue CPAP treatment due to side effects. Unintentional leakage and its associated annoying consequences are the most frequently reported adverse effects of CPAP. Successive technological improvements have not succeeded in addressing this issue. A systematic review was conducted (1) to assess the impact of different technological advances on unintentional leaks and (2) to determine if any patient characteristics have already been identified as determinants of unintentional leakage. No CPAP modality was superior to another in reducing unintentional leaks and, surprisingly, oronasal masks were associated with higher unintentional leaks. Nasal obstruction, older age, higher BMI, central fat distribution, and male sex might be associated with an increased risk of unintentional leakage. Such leaks remain an important problem. Further studies are needed to improve the understanding of underlying clinical factors so that patients at risk of unintentional leaks may be identified and individualized solutions applied.

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