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Original Research |

Impact of acute changes in CPAP flow route in sleep apnea treatment

R.G.S. Andrade; F. Madeiro; V.S. Piccin; H.T. Moriya; F. Schorr; P.S. Sardinha; G.M. Gregório; P.R. Genta; G. Lorenzi-Filho
Author and Funding Information

Author contributions: Each author had full access to the data and takes responsibility for the integrity and accuracy of the analysis. All authors contributed to and approved of the final submitted manuscript.

Funding Sources: No potential conflict of interest exist with any companies/organizations whose products or services may be discussed in this article.

Corresponding Author: Correspondence and requests for reprints should be addressed to Geraldo Lorenzi-Filho, Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Av. Enéas Carvalho de Aguiar 44, São Paulo, Brazil.


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


Chest. 2016. doi:10.1016/j.chest.2016.04.017
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Abstract

Introduction  CPAP is the gold standard treatment for obstructive sleep apnea (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 effectiveness to treat OSA

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

Results  Nasal CPAP (14.8±4.1 cmH2O) was able to stabilize breathing in all patients. In contrast, CPAP delivered by the oronasal and oral route promoted obstructive events in 12 (66.7%) and 14 (87.5%) patients, respectively. Compared to 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 oronasal and oral route, respectively

Conclusions  CPAP delivered through the oronasal route may compromise CPAP effectiveness to treat OSA.


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