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Editorial |

The High Road, the Low Road, or Both: Effects of Positive Airway Pressure Route of Administration on Treatment Efficacy for OSA

Nicholas J. Cutrufello, MD; Lee K. Brown, MD, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: L. K. B. has participated in advisory panels for Philips Respironics and is an insurance claims reviewer for Considine and Associates, Inc. He coedits the sleep and respiratory neurobiology section of Current Opinion in Pulmonary Medicine, wrote on CPAP treatment for obstructive sleep apnea in UpToDate and on obstructive sleep apnea in Clinical Decision Support: Pulmonary Medicine and Sleep Disorders. He is currently coediting an issue of Sleep Medicine Clinics on positive airway pressure therapy. He serves on the Polysomnography Practice Advisory Committee of the New Mexico Medical Board and chairs the New Mexico Respiratory Care Advisory Board. None declared (N.J.C).

aDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM

bDepartment of Electrical and Computer Engineering, University of New Mexico School of Engineering, Albuquerque, NM

CORRESPONDENCE TO: Lee K. Brown, MD, FCCP, Department of Internal Medicine, School of Medicine; and School of Engineering, University of New Mexico, 1101 Medical Arts Ave NE, Bldg No. 2, Albuquerque, NM 87102


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


Chest. 2016;150(6):1174-1176. doi:10.1016/j.chest.2016.09.031
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Extract

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.

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