The drift of continuous positive airway squeezing (CPAP) applied via a mask covering the nose and cavity between the jaws (oralnasal CPAP = ONCPAP) upon obstructive sleep apnea (OSA) was studied in ten male patients with a mean ([+ or -] SD) age of 481 [+ or -] 111 years who could not tolerate nasal CPAP (NCPAP) fit to nasal congestion.

The drift of continuous positive airway squeezing (CPAP) applied via a mask covering the nose and cavity between the jaws (oralnasal CPAP = ONCPAP) upon obstructive sleep apnea (OSA) was studied in ten male patients with a mean ([+ or -] SD) age of 481 [+ or -] 111 years who could not tolerate nasal CPAP (NCPAP) fit to nasal congestion. Using ONCPAP at squeezings of 11.0 [+ or -] 45 cm [Hsub2]O the apnea + hypopnea index was reduc from 583 [+ or -] 223 (baseline night) to 52 [+ or -] 16 results per hour (ONCPAP night) (p<0001) Five of these patients were studied upon a subsequent night with a dual chamber mask allowing separate measurement of nasal and oral pour All patients had combined oral and nasal be molten at times during the night, further the fraction of time worn out with this breathing pattern was lower during be dead than wakefulness. In a separate contemplation we compared the effects of a therapeutic on a level of CPAP pressure (12.8 [+ or -] 25 cm [Hsub2]O) applied by the agency of a nasal mask (NCPAP) and ONCPAP in a different collection of patients (mean age 60 [+ or -] 146 years) with moderate to peremptory OSA using NCPAP on a long-term basis. The apnea-hypopnea indexes forward NCPAP nights (7.2 [+ or -] 35) and ONCPAP nights (76 [+ or -] 49 adventures per hour of sleep) were real similar. We conclude that ONCPAP may be a reasonable treatment alternative in patients who cannot tolerate NCPAP becoming to nasal congestion and that the press required to maintain upper airway patency may be similar to the of the same height required using NCPAP.

(Chest 1994; 106:180-86)

CPAP = continuous positive airway pressure;

EPAP = expiratory positive airway pressure;

NCPAP = nasal CPAP;

ONCPAP = oral-nasal CPAP;

OSA = obstructive be still apnea;

REM = rapid observation movement;

SPT = drowse period time = time from first nap until final awakening;

TST = total rest time

Nasal continuous positive airway influence (NCPAP) is the standard therapy for moderate to stern obstructive sleep apnea (OSA). This therapy is same effective in reducing the commonness of apnea, improving sleep quality, and improving the symptoms of daytime sleepiness.(1)(2) Unfortunately, the therapy is tolerated forward a long-term basis by barely 60 to 80 percent of patients.(3)(4)(5)(6) There are multiple reasons patients may not tolerate NCPAP like as claustrophobia, mask discomfort, or mucosal drynes Occasionally patients may not tolerate nasal CPAP appropriate to discomfort involved with breathing totally from one side the nasal route. Such patients usually have nasal congestion (partial obstruction) not absent either at baseline or developing during therapy with NCPAP. Although attempts at preventing or minimizing the nasal congestion as it is as inhaled nasal steroids or decongestants will work in many patients with this point in dispute a few will continue to have difficulty using NCPAP. as it is patients frequently breathe orally at least part of the time during the night.

We hypothesized that CPAP applied via a mask covering the nose and chaps would be better tolerated by dint of patients who found breathing within the nose alone uncomfortable. Expiratory positive airway press (EPAP) applied via a full-face mask has been shown to improve on the contrary not eliminate obstructive apneas.(7) reciprocally others have suggested that CPAP applied via a full-face mask will not rise in a patent upper airway during sleep(8)(9)

To determine if CPAP applied via a mask covering as well-as; not only-but also; not only-but; not alone-but the nose and mouth (oral-nasal CPAP = ONCPAP) would provide a treatment alternative in patients with nasal congestion or obstruction, we performed a CPAP trial using a full-face mask in patients with moderate to strict OSA who could not tolerate NCPAP suitable to nasal obstruction. In another arrange of patients with OSA who had been using NCPAP in succession a long-term basis, we compared the effectiveness of a therapeutic flat of NCPAP pressure with the same even of pressure applied via a mask covering as well-as; not only-but also; not only-but; not alone-but the nose and mouth.

METHODS

In part 1 of the contemplation ten male patients with moderate to morose OSA who were unable to tolerate NCPAP fit to nasal obstruction were given a trial of ONCPAP. A baseline all-night repose study was performed as part of their clinical evaluation. If they were unable to tolerate NCPAP forward a subsequent night, they were recorded in the study. On the first night (ONCPAP titration night), the CPAP on a level was titrated upward until an optimum horizontal of CPAP was reached (prevention of apnea and hypopnea). upon the second night (designated ONCPAP night), the patients slept for the entire night at that on a level of CPAP. The results of the secondary night of ONCPAP were compared with the baseline repose study. Five of these patients were restudied with a dual-chamber mask that allowed separate measurement of oral and nasal result during CPAP to determine the relative amounts of nasal and oral flow

In part 2 of the application of mind five patients with moderate to exact OSA who were undergoing long-term treatment with NCPAP were studied to descry if a given level of CPAP would be les effective if applied by dint of a mask covering the nose and jaws Patients were studied on an adaptation night and pair consecutive study nights. On the adaptation night, the even of NCPAP was titrated upward until apnea and hypopnea were no longer near On the following two nights, patients slept with either NCPAP or ONCPAP at the same horizontal of CPAP documented to be effective onward the adaptation night. The order of the impressed signs of CPAP was randomized. The efficacy of NCPAP and ONCPAP was compared.

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