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.
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.
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.
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.