Chest
Volume 123, Issue 4, April 2003, Pages 1112-1118
Journal home page for Chest

Clinical Investigations
SLEEP AND BREATHING
Clinical Outcomes Related to Interface Type in Patients With Obstructive Sleep Apnea/Hypopnea Syndrome Who Are Using Continuous Positive Airway Pressure

https://doi.org/10.1378/chest.123.4.1112Get rights and content

Study objectives:

To evaluate the effect of interface on objective compliance, patient satisfaction, adverse effects, quality of life, and residual sleep-disordered breathing in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) using continuous positive airway pressure (CPAP).

Design:

Randomized, cross-over.

Setting:

Two suburban community-based hospital sleep laboratories.

Patients:

Data were collected on 39 patients with OSAHS (mean age, 48.7 years), in whom CPAP was a novel treatment.

Interventions:

Interventions were nasal pillows (Breeze; Mallinckrodt Corporation; Minneapolis, MN) and nasal mask (Contour; Respironics; Murrysville, PA).

Measurements and results:

Outcomes assessed at the completion of each 3-week treatment period were objective compliance, adverse effects, and satisfaction with CPAP (CPAP questionnaire), daytime sleepiness (Epworth sleepiness scale [ESS]), quality of life (Functional Outcomes of Sleep Questionnaire [FOSQ]), sleep diary, and residual sleep-disordered breathing (apnea-hypopnea index [AHI]). Patients were randomly assigned to use the nasal pillows or the nasal mask following laboratory titration and initiated on CPAP (pressure range, 5 to 14 cm H2O). The percentage of days utilized favored the nasal pillows (94.1% vs 85.7%; p = 0.02), but minutes of use per night did not differ (nasal pillows, 223 min; nasal mask, 288 min). ESS scores were lower and the FOSQ total scores were higher following CPAP treatment (p < 0.001), but no differential treatment effects were noted. Fewer adverse effects, less trouble getting to sleep and staying asleep, and less air leak were reported with nasal pillows (p < 0.04). The mean ± SD pretreatment AHI (47.1 ± 35.1/h) was significantly lower following treatment with CPAP for both types of interface (nasal pillows, 10.2 ± 9.8/h; nasal mask, 7.0 ± 7.7/h; p < 0.001).

Conclusions:

Nasal pillows are a well-tolerated and effective interface for OSAHS patients receiving CPAP at ≤ 14 cm H2O. Use of nasal pillows was associated with fewer adverse effects and better sleep quality during the first 3 weeks of CPAP therapy. Further investigation is needed to determine whether interface type affects long-term CPAP use.

Section snippets

Subjects

Eligible patients were between 18 years and 70 years of age, had an OSAHS diagnosis (apnea-hypopnea index [AHI] ≥ 15/h or AHI ≥ 5 plus daytime sleepiness),11 and had not received CPAP treatment previously. Exclusion criteria included wake resting arterial oxygen saturation < 90%, evidence of upper airway tract infection or flu-like symptoms at the time of titration, elective surgery scheduled before conclusion of the study, or prior surgical intervention for OSAHS. Patients were not eligible if

Patient Characteristics

Forty-two patients were enrolled in the study. Three patients were unable to complete the protocol. One patient traveled to Europe and was unable to use the equipment. An unrelated medical condition developed in one patient; he was dropped from the study but maintained on CPAP treatment. One patient was unavailable for follow-up.

Thirty-nine patients completed the 6-week protocol. Twenty-four patients underwent full-night CPAP titrations, and 15 patients underwent split-night studies. Twenty

Discussion

This is the first report of CPAP use, adverse effects, and residual sleep-disordered breathing with nasal pillows, when compared to nasal mask. Fewer overall adverse effects, including less air leak and better self-reported sleep quality, were reported when CPAP was used with nasal pillows. Attempted CPAP use during the first 3 weeks of therapy favored nasal pillows, but use per night did not differ between the two types of interface. The greater attempt at CPAP use with nasal pillows was

References (30)

  • C Jenkinson et al.

    Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomized prospective parallel trial

    Lancet

    (1999)
  • HM Engleman et al.

    Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome

    Lancet

    (1994)
  • CA Massie et al.

    Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure

    Chest

    (1999)
  • A Kalan et al.

    Adverse effects of nasal continuous positive airway pressure therapy in sleep apnoea syndrome

    J Laryngol Otol

    (1999)
  • NB Kribbs et al.

    Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea

    Am Rev Respir Dis

    (1993)
  • Cited by (107)

    • Positive airway pressure I: Equipment

      2020, Obesity Hypoventilation Syndrome: From Physiologic Principles to Clinical Practice
    View all citing articles on Scopus

    This study was supported by a grant from Mallinckrodt Corporation. No other payments, excluding the cost of conducting the study, were made to the authors. The authors have no proprietary, financial, or equity interest in either the sponsor or the product. The authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and the accuracy of the data analysis. Mallinckrodt Corporation assisted in the design of the study, but had no involvement in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit for publication.

    View full text