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Continuous Positive Airway Pressure : By Nose or Mouth?

Michael R. Littner, MD, FCCP
Author and Funding Information

Affiliations: Los Angeles, CA
 ,  Dr. Littner is affiliated with the Pulmonary, Critical Care, and Sleep Medicine Division, Veterans Affairs Greater Los Angeles Healthcare System, and is Professor of Medicine, David Geffen School of Medicine, University of California at Los Angeles.

Correspondence to: Michael R. Littner, MD, FCCP, Pulmonary Department, 16111 Plummer St (111P), Building 200, Room 3534, North Hills, CA 91343



Chest. 2003;123(3):662-664. doi:10.1378/chest.123.3.662
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Extract

Treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) is less than ideal, not because the concept is incorrect but because the delivery is cumbersome and patients find it difficult to adapt to its use. Apart from being anchored to a mask, tubing, and a potentially noisy pressure-generating device, there may be nasal discomfort, nasal congestion, nasal obstruction, claustrophobia, the feeling of being either overventilated or underventilated, and mouth and mask leaks that make acceptance and adherence with nasal CPAP difficult for many patients. Several approaches14 have had some success in overcoming the disadvantages of CPAP including heated humidification, chin straps, treatment of nasal congestion both pharmacologically and surgically, use of hypnotics, different types of interfaces such as nasal cannulas, or a full-face mask (also called an oronasal mask). Despite these approaches, adherence and acceptance are less than ideal.5

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