Choosing the right mask for your Asian patient with sleep apnoea: A randomized, crossover trial of CPAP interfaces

Background and objective A major challenge with the treatment of obstructive sleep apnoea (OSA) is adherence to continuous positive airway pressure (CPAP) therapy. Mask tolerability is an important determinant of adherence, however evidence to guide selection of mask interfaces is lacking. Methods We conducted a randomized crossover trial of mask interfaces in CPAP therapy for moderate-to-severe OSA to assess adherence and efficacy of CPAP therapy with nasal mask, nasal pillow and oronasal masks. Demographic data, Nasal Obstruction Symptom Evaluation (NOSE) scores and craniofacial measurements were also analysed for associations with adherence with oronasal masks. Results Eighty-five patients were included in the study (mean +/- SD age: 46 +/- 12 years; body mass index: 29.9 +/- 5.6 kg/m(2); apnoea-hypopnoea index (AHI): 53.6 +/- 24.0 events/h). Patients had better adherence with nasal masks (average night use: 3.96 +/- 2.26 h/night) compared to oronasal masks (3.26 +/- 2.18 h/night, P < 0.001) and nasal pillows (3.48 +/- 2.20 h/night, P = 0.007). Residual AHI was higher with oronasal masks (7.2 +/- 5.2) compared to nasal masks (4.0 +/- 4.2, P < 0.001) and nasal pillows (4.1 +/- 3.3, P < 0.001). Twenty-two (25.9%) patients had the best adherence with oronasal masks (4.22 +/- 2.14 vs 2.93 +/- 2.12 h/night, P = 0.016). These patients had lower NOSE scores (15 (0-35) vs 40 (10-55), P = 0.024) and larger menton-labrale inferioris/biocular width ratios (31 +/- 3% vs 28 +/- 4%, P = 0.019). Conclusion Nasal masks are the preferred interface during CPAP initiation. Patients with less nasal obstruction and a proportionally increased chin-lower lip distance to mid-face width may have better CPAP adherence with an oronasal mask interface.