The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Andrea Lanza1, Sara Mariani2, Maurizio Sommariva2, Katrina Sambusida1, Petra Subert2, Paola Proserpio1, Lino Nobili1; 1Centre of Sleep Medicine, Niguarda Hospital, Milan, Italy; 2Physical Therapy and Rehabilitation Centre, Niguarda Hospital, Milan, Italy

Backgrounds: Inadequate adherence to CPAP therapy is the major hurdle when facing with obstructive sleep apnea (OSA) treatment. Mask discomfort is a common reason for low adherence or stop using CPAP. Nowadays there are alternatives to standard nasal masks, such as nasal pillows. These are not recommended as first line interface and there are no data about their long term efficacy. Our purpose is to asses long term effectiveness and adherence to CPAP treatment in OSA patients choosing nasal pillows as initial therapeutic option. Patients and Methods: 70 consecutive CPAP naive patients (pts) affected by moderate-to-severe OSA: 55 M; age 60.0 +/- 11.5; Body Mass Index (BMI) 31.8 +/- 6.2; Epworth Sleepiness Scale (ESS) score 9.6 +/- 5.3; Apnea-Hypopnea Index (AHI) 42.6 +/- 19.0/h; Oxygen Desaturation Index 40.4 +/- 19.3/h; Mean SpO2 91.8 +/- 3.1%. Pts underwent an ambulatory CPAP initiation performed by an experienced respiratory physiotherapist. Pts were allowed to self-select the type of nasal interface they preferred to start the therapy, choosing among 9 models of nasal-masks and 3 of nasal-pillows. Only in case of side effects due to nasal CPAP, pts switched to face mask (12 models available). Pts were encouraged to report side effects and ask for changing mask if needed. Outcomes were assessed after 5 days, 2 and 8 months. Results: 33 (47.1%) pts chose nasal-pillows, 16 (22.9%) standard nasal-mask, while 21 (30%) needed a face-mask. These three groups didn't differ in age, gender, BMI, and baseline AHI. Mean CPAP pressure was 11.2 with nasal-pillows, 11.7 with nasal and 11.9cmH2O with face-mask. Side effects were reported in 38 (54%) pts without differences in groups. 14 pts changed type of mask and 13 changed model maintaining the same type. During the course of the study 1 pt refused treatment during titration, 1 lost weight and stopped therapy and 5 dropped out. 63 patients reached the 8-month follow-up. Mean daily CPAP use was 5.1 +/- 1.7 with nasal-pillows, 5.4 +/- 1.1 with nasal and 5.2 +/- 1.6h/night with face-mask. In all groups AHI remained less than 5/h and ESS was significantly reduced. The preference for nasal-pillows was confirmed: 25 pts after 8 months were using nasal-pillows, 14 nasal and 19 face-mask. 5 pts alternated pillows with nasal or face-masks. Conclusions: nasal-pillows, the most frequently self-selected interface in our group patients, are well-tolerated and show equal long term effectiveness and objective adherence as standard nasal mask in the treatment of OSA.
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