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Chest. 2018 Mar;153(3):665-674. doi: 10.1016/j.chest.2017.10.044. Epub 2017 Dec 19.

Nasal vs Oronasal CPAP for OSA Treatment: A Meta-Analysis.

Author information

1
Sleep Laboratory of the Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.
2
School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia.
3
Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, HCFMUSP, São Paulo, Brazil; Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich, Germany.
4
Sleep Laboratory of the Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil. Electronic address: geraldo.lorenzi@incor.usp.br.

Abstract

BACKGROUND:

Nasal CPAP is the "gold standard" treatment for 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 nonrandomized trials that compared nasal vs oronasal masks on CPAP level, residual apnea-hypopnea index (AHI), and CPAP adherence to treat OSA.

METHODS:

The 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 nonrandomized trials; and (3) comparison between nasal and oronasal CPAP including pressure level, and/or residual AHI, and/or CPAP adherence.

RESULTS:

We identified five randomized and eight nonrandomized 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 with nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g, -0.59; 95% CI, -0.82 to -0.37; P < .001) (on average, +1.5 cm H2O), higher residual AHI (Hedges' g, -0.34; 95% CI, -0.52 to -0.17; P < .001) (+2.8 events/h), and a poorer adherence (Hedges' g, 0.50; 95% CI, 0.21-0.79; P = .001) (-48 min/night).

CONCLUSIONS:

Oronasal masks are associated with a higher CPAP level, higher residual AHI, and poorer adherence than nasal masks.

TRIAL REGISTRY:

PROSPERO database; No.: CRD42017064584; URL: https://www.crd.york.ac.uk/prospero/.

KEYWORDS:

CPAP; OSA; oronasal mask

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