O ye'll tak' the high road, and I'll tak' the low road,And I'll be in Scotland afore ye,Traditional Scottish Song
When it comes to positive airway pressure (PAP) treatment for OSA, there has been surprisingly little debate concerning the relative efficacy of using the “high road” (nasal route) vs the “low road” (oral route). In the seminal report by Sullivan et al, the nasal route was chosen by reasoning that with the mouth outside of the circuit, a “safety valve” was present should the apparatus malfunction and overpressurize, and there would be an alternate breathing route should the nasal circuit occlude. Thus, nasal masks were the only available interfaces in the early days of continuous PAP (CPAP) until Sanders et al and Prosise and Berry reported the successful administration of CPAP through oronasal interfaces in 1994. Although Prosise and Berry did entertain the possibility that oronasal CPAP might fail to displace the tongue anteriorly, and therefore not adequately suppress obstruction, oronasal interfaces and a few oral-only interfaces soon appeared in the marketplace.