Assessment of the Performance of Nasal Pillows at High CPAP Pressures

Study Objectives: Compliance with CPAP therapy remains an issue despite its effectiveness. Mask selection is likely to affect a patients experience with CPAP, and multiple mask options are currently available. Nasal pillows have less contact with the face compared to nasal masks and may benefit patients by minimizing side effects; however, they are infrequently used at high CPAP pressures. The aim of this study was to examine the performance of nasal pillows at pressures >= 12 cm H2O compared with nasal masks. Methods: Twenty-one subjects were recruited. Participants were randomized to Swift FX nasal pillows and their current nasal mask for 7 consecutive nights each in a prospective crossover trial. Objective device data and subjective feedback were collected. Results: There were no differences in objective device data of nasal pillows vs. nasal masks: Daily Usage 7.4 +/- 1.4 vs 7.2 +/- 1.4 (h/night); 95th%ile Leak 28.6 +/- 13.5 vs 27.9 +/- 17.9 (L/min); AHI 1.9 +/- 1.3 vs 1.7 +/- 1.1, respectively (all p-values > 0.05). There were no differences between the nasal pillows and nasal masks for subjective ratings of comfort, seal, red marks, side effects such as jetting and dry nose/mouth, and overall performance (all p-values > 0.05). The nasal pillows were rated to be less obtrusive and claustrophobic (both p-values < 0.01), but less stable (p = 0.04). Overall preference was 50% nasal pillows, 45% nasal masks; 5% found no difference. Conclusion: Nasal pillows are as efficacious as nasal masks at CPAP pressures >= 12 cm H2O and are a suitable option for patients requiring high CPAP pressures. Clinical Trial Registration: NIH Clinical Trials Registry. http://clinicaltrials.gov. Title: Nasal Pillows at High CPAP Pressure. Identifier: NCT01690923.