Nasal versus oronasal CPAP for obstructive sleep apnea treatment: a meta-analysis.

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Nasal versus oronasal CPAP for obstructive sleep apnea treatment: a meta-analysis.

Chest. 2017 Dec 19;:

Authors: Andrade RGS, Viana FM, Nascimento JA, Drager LF, Moffa A, Brunoni AR, Genta PR, Lorenzi-Filho G

Abstract
BACKGROUND: Nasal continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and non-randomized trials that compared nasal versus oronasal masks on CPAP level, residual apnea-hypopnea index (AHI) and CPAP adherence to treat OSA.
METHODS: Cochrane Central Register of Controlled Trials, Medline and Web of Science were searched for relevant studies in any language with the following terms: "sleep apnea" AND "CPAP" OR "sleep apnea" AND "oronasal mask" OR "OSA" AND "oronasal CPAP" OR "oronasal mask" AND "adherence". Studies on CPAP treatment for OSA were included based on the following criteria: (1) original article; (2) randomized or non-randomized trials; (3) comparison between nasal and oronasal CPAP included pressure level, and/or residual AHI, and/or CPAP adherence.
RESULTS: We identified 5 randomized and 8 non-randomized trials (4,563 patients) that reported CPAP level and/or residual AHI and/or CPAP adherence. Overall, the random-effects meta-analysis revealed that as compared to nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g= -0.59, 95% CI -0.82 to -0.37, p<0.001) (on average + 1.5 cmH2O), higher residual AHI (Hedges' g= -0.34, 95% CI -0.52 to -0.17, p<0.001) (+ 2.8 events/h) and a poorer adherence (Hedges' g= 0.50, 95% CI 0.21 to 0.79, p=0.001) (- 48 minutes/night).
CONCLUSIONS: Oronasal masks are associated with a higher CPAP level, higher residual AHI and a poorer adherence than nasal masks.

PMID: 29273515 [PubMed - as supplied by publisher]

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