The SomnuSeal Oral Mask Is Reasonably Tolerated by Otherwise CPAP Noncompliant Patients with OSA

High-flow nasal cannula ventilation therapy for obstructive sleep apnea in ischemic stroke patients requiring nasogastric tube feeding: a preliminary study

Obstructive sleep apnea (OSA) is associated with increasing risk of recurrent stroke and mortality. Nasogastric tubes used by dysphagic stroke patients may interfere with nasal continuous positive airway pressure (CPAP) due to air leakage. This study was evaluated the effects and short-term tolerability of high-flow nasal cannula (HFNC) therapy for OSA in stroke patients with nasogastric intubation. The HFNC titration study was performed in post-acute ischemic stroke patients with nasogastric intubation and OSA. Then, participants were treated with HFNC therapy in the ward for one week. Eleven participants (eight males) who were all elderly with a median age of 72 (IQR 67-82) years and a body mass index of 23.5 (IQR 22.0-26.6) completed the titration study. The HFNC therapy at a flow rate up to 50~60 L/min significantly decreased the apnea-hypopnea index from 52.0 events/h (IQR 29.9-61.9) to 26.5 events/h (IQR 3.3-34.6) and the total arousal index from 34.6 (IQR 18.6-42.3) to 15.0 (IQR 10.3-25.4). The oxygen desaturation index was also significantly decreased from 53.0 events/h (IQR 37.0-72.8) to 16.2 events/h (IQR 0.8-20.1), accompanied by a significant improvement in the minimum SpO2 level. Finally, only three participants tolerated flow rates of 50~60 L/minute in one-week treatment period. Conclusively, HFNC therapy at therapeutic flow rate is effective at reducing the OSA severity in post-acute ischemic stroke patients with nasogastric intubation. Owing to the suboptimal acceptance, HFNC might be a temporary treatment option, and CPAP therapy is suggested after the nasogastric tube is removed.

Oronasal mask may compromise the efficacy of continuous positive airway pressure on OSA treatment: is there evidence for avoiding the oronasal route?

PURPOSE OF REVIEW

Continuous positive airway pressure (CPAP) delivered by nasal mask is the gold standard treatment for obstructive sleep apnea (OSA). However, oral and oronasal masks are also available. We considered experimental evidence and reviewed clinical trials that evaluated the impact of oral and oronasal mask on OSA treatment.

RECENT FINDINGS

One recent study in 18 OSA patients that slept with a customized oronasal mask with two sealed compartments showed that the change of CPAP flow from nasal to oronasal and oral caused upper airway obstruction because of posterior displacement of the tongue demonstrated by nasoendoscopy. Oral masks use a mouthpiece that may stabilize the jaw and the tongue and have shown to be effective. However, oral masks are not widely used in clinical practice. Four out of five observational studies and all five reviewed randomized studies showed a worse performance of oronasal when compared with nasal masks. Oronasal masks were associated with higher residual apnea-hypopnea index, lower adherence, more leaks, and less satisfaction than nasal mask in the majority of the studies.

SUMMARY

Nasal CPAP must be the first choice to treat OSA. Patients on oronasal mask should be carefully followed. VIDEO ABSTRACT.

The Effect of the Transition to Home Monitoring for the Diagnosis of OSAS on Test Availability, Waiting Time, Patients' Satisfaction, and Outcome in a Large Health Provider System

During 2009, the Haifa district of Clalit Health Services (CHS) has switched from in-lab polysomnography (PSG) to home studies for the diagnosis of obstructive sleep apnea (OSA). We assessed the effects of this change on accessibility, waiting time, satisfaction, costs, and CPAP purchase by the patients. Data regarding sleep studies, CPAP purchase, and waiting times were collected retrospectively from the computerized database of CHS. Patients' satisfaction was assessed utilizing a telephone questionnaire introduced to a randomized small sample of 70 patients. Comparisons were made between 2007 and 2008 (in-lab PSGs) and 2010 and 2011 (when most studies were ambulatory). Of about 650000 insured individuals in the Haifa district of CHS, 1471 sleep studies were performed during 2007-2008 compared to 2794 tests during 2010-2011. The average waiting time was 9.9 weeks in 2007-2008 compared to 1.1 weeks in 2010-2011 (P < 0.05). 597 CPAPs were purchased in 2007-2008 compared to 831 in 2010-2011. The overall patients' satisfaction was similar, but discomfort tended to be higher in the in-laboratory group (4.1 vs 2.7 in a scale of 0-10; P = 0.11). Switching to ambulatory diagnosis improved the test accessibility and reduced the waiting times. Patients' satisfaction remained similarly high. The total direct cost of OSA management was reduced.

The SomnuSeal Oral Mask Is Reasonably Tolerated by Otherwise CPAP Noncompliant Patients with OSA

Compliance with CPAP is the major limiting factor in treating patients with OSA. The novel SomnuSeal mask is an oral self-adaptable mask located between the teeth and the lips ensuring that there are no air leaks or skin abrasions. Fifty patients with AHI > 20, who failed previous CPAP trials, were asked to sleep with the mask for one month. In all patients, the mask was connected to an AutoPAP machine with a heated humidifier. Efficacy, convenience, and compliance (average usage for 4 or more hours per night) were monitored. Fifty patients (41 m and 9 f, mean age 57 ± 12 years, BMI 33.6 ± 4.9 kg/m(2), and AHI 47 ± 23/h) participated. Eleven were classified as compliant (average mask usage of 26 nights, 4.7 hours per night), five were only partially compliant (average usage of 13 nights, 2.9 hours per night), and 34 could not comply with it. In all patients who slept with it, the efficacy (assessed by residual AHI derived from the CPAP device) was good with an AHI of less than 8/hour. Interestingly, the required optimal pressure decreased from an average of 9.3 cmH2O to 4.6 cmH2O. The SomnuSeal oral interface is effective and may result in converting noncompliant untreated patients with OSA into well-treated ones.