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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

Conflict of interest:

ML, NA, DZ and JCB are employees of “AGIR à dom.”, a non-profit home care provider. JCB has received grants, personal fees, and non-financial support from Philips healthcare, RESMED outside the context of the submitted work. JCB has also a patent with NOMICS SA. The others authors (JBM, RT and JLP) have no conflicts to disclose linked to this work.

Association AGIR à dom. Research and Development; HP2 Laboratory, INSERM U 1042

CHU UCL, Site Sainte Elisabeth

Association AGIR à dom. Research and Development; HP2 Laboratory, INSERM U 1042

Association AGIR à dom. Research and Development Department

Sleep Laboratory, Thorax and vessels division Grenoble Alpes University; HP2 Laboratory, INSERM U 1042

Sleep Laboratory, Thorax and vessels division Grenoble Alpes University; HP2 Laboratory, INSERM U 1042

Association AGIR à dom. Research and Development; HP2 Laboratory, INSERM U 1042

Correspondence to: Marius LEBRET, PT, MSc, Agir à dom, 36 Chemin du Vieux Chêne, 38244 Meylan, France.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.11.049
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Abstract

Continuous positive airway pressure (CPAP) is the first-line treatment for moderate to severe obstructive sleep apnea syndrome (OSAS). Up to 25% of patients with OSAS discontinue CPAP treatment due to side effects. Unintentional leak and its associated annoying consequences are the most frequently reported adverse effects of CPAP. Successive technological improvements have not succeeded in addressing this issue.

Objectives  A systematic review was conducted: (i) to assess the impact of different technological advances on unintentional leak and, (ii) to determine if any patient characteristics have already been identified as determinants of unintentional leak.

Results  no CPAP modality was superior to another in reducing unintentional leak and, surprisingly, oro-nasal masks were associated with higher unintentional leak. Nasal obstruction, older age, higher body mass index, central fat distribution and male gender might be associated with an increased risk of unintentional leak.

Conclusion  unintentional leak remains an important problem. Further studies are needed to improve understanding of underlying clinical factors so that patients at risk of unintentional leak may be identified and individualized solutions applied.


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