PT  - JOURNAL ARTICLE
AU  - Marius LEBRET
AU  - Nathalie ARNOL
AU  - Jean-Benoît MARTINOT
AU  - Loïc LAMBERT
AU  - Renaud TAMISIER
AU  - Jean-Louis PEPIN
AU  - Jean-Christian BOREL
TI  - Determining factors of unintentional leak during CPAP treatment in obstructive sleep apnoea syndrome
AID  - 10.1183/23120541.sleepandbreathing-2017.P42
DP  - 2017 Apr 01
TA  - ERJ Open Research
PG  - P42
VI  - 3
IP  - suppl 1
4099  - http://openres.ersjournals.com/content/3/suppl_1/P42.short
4100  - http://openres.ersjournals.com/content/3/suppl_1/P42.full
SO  - erjor2017 Apr 01; 3
AB  - Objectives i) To identify determining factors of UL under CPAP during sleep ii) to determine if these factors are modulated by the type of mask.Methods This study is an analysis of in-lab PSG recordings: PSG were supplemented with a movement magnetic sensor that measured mandibular behavior (mouth opening and mandibular oscillations-a surrogate marker of respiratory effort). Continuous variables (mouth opening, mandibular oscillations, pressure) were computed as mean values over non-overlapping 10 seconds intervals. Categorical data (sleep position, sleep stage) and dichotomous data (presence of respiratory events, micro-arousals (µA) and UL (>0 L/sec): yes vs no) were also reported by 10-second intervals. Univariate and multivariate conditional regression models estimated the risk of UL during an interval T according to the variables at the previous interval (T-1). A sensitivity analysis for nasal and oronasal masks (ONM) was conducted.Results 74 PSG were analyzed (51 males; 56±13years; BMI=34±6kg/m2; baseline AHI=47±23/h). In univariate analysis mouth opening (≥median/patient), CPAP pressure (≥median/patient), position (other vs supine), and REM sleep increased the risk of UL; µA decreased it. In multivariate analysis, the same variables plus mandibular oscillations (>0,3mm) remained independently associated with the risk of UL; in contrast, a respiratory event or a µA at T-1 reduced the risk of UL. In the sensitivity analysis, ONM reduced the risk of UL in case of mouth opening, mandibular oscillation or REM sleep.Conclusion Mouth opening, respiratory effort, CPAP pressure, sleep position and REM sleep are determining factors of UL. ONM may decrease this risk.