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Cited by 149Obstructive Sleep Apnea ResearchSleep and related disordersRespiratory Support and Mechanisms

Comparison of nose and face mask CPAP therapy for sleep apnoea

Open access
Mortimore, I L, Whittle, A T, Douglas, N J·1998·Thorax
DOI 10.1136/thx.53.4.290PMC PMC1745186
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Abstract

BACKGROUND: Many patients with sleep apnoea/hypopnoea syndrome (SAHS) find nasal continuous positive airway pressure (CPAP) treatment unsatisfactory due to side effects related to mouth air leakage. A study was performed to compare side effects with face mask and nose mask CPAP therapy in patients with SAHS, with and without uvulopalatopharyngoplasty (U3P). METHODS: Twenty newly diagnosed patients with SAHS took part in a randomised double limb trial of face or nose mask CPAP therapy (four weeks per limb) in which CPAP compliance in terms of machine run time was measured and patients answered a symptom questionnaire on side effects resulting from the mask. Ten patients with SAHS with U3P (SAHS/U3P) who were already regular users of nasal CPAP were also given a four week trial of face mask CPAP to compare compliance and symptoms. Ten patients with SAHS were matched with the 10 SAHS/U3P patients for body mass index, age, apnoea/hypopnoea index, and CPAP pressure. Long term compliance was estimated one year after the mask comparison studies. RESULTS: For patients with SAHS nightly compliance was higher with a nose mask (mean (SE) 5.3 (0.4) hours/night CPAP) than with a face mask (4.3 (0.5) hours/night CPAP), p = 0.01 (mean difference 1.0 hour/night, 95% CI 1.8 to 0.3). Nose masks were rated more comfortable by 19 of 20 patients (p < 0.001) despite more mouth leak related symptoms. For SAHS/U3P patients compliance was marginally higher with nose masks (5.1 (0.7) hours/night CPAP) than with face masks (4.0 (0.8) hours/night CPAP), p = 0.07 (mean difference 1.1 hour/night, 95% CI 2.1 to 0.1). Nose masks were rated more comfortable by seven of 10 patients. There were no significant differences in side effect scores with face and nose masks. At one year nine of 10 SAHS patients and nine of 10 SAHS/U3P patients were still using CPAP. Compliance was 5.4 (0.6) hours/night for the SAHS patients and 3.5 (0.4) hours/night for the SAHS/U3P patients, p = 0.02 (mean difference 1.9 hour/night, 95% CI 3.6 to 0.3). CONCLUSIONS: Compliance is greater with nose mask CPAP than with face mask CPAP because the overall comfort is better and compensates for increased symptoms associated with mouth leakage. Improved face mask design is needed.

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  • A meta-analysis of 2 RCTs demonstrated no clinically significant difference in self-reported sleepiness between oronasal and nasal interfaces as assessed with the ESS.

    “The meta-analysis demonstrated no clinically significant difference in self-reported sleepiness between the interfaces as assessed with the ESS (see supplemental material, Figure S98).”

    From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [244]

    The Randomised Trial section confirms that this paper compared nose and face masks and measured sleepiness with the Epworth score. It reports a lower score with the nose mask (8.2 versus 9.8, p<0.01). This paper is one trial, not a meta-analysis of two RCTs, and it does not establish the claimed pooled result or assess whether the difference was clinically significant. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Nasal interfaces improve PAP adherence compared to oronasal interfaces, with a mean difference of 0.6 h/night (95% CI: -0.2 to 1.3 h/night) in RCTs.

    “The efficacy of oronasal compared with nasal interfaces for improving adherence was evaluated in meta-analyses of 3 cross-over RCTs of 3 to 4 weeks duration, 244,245,248 which demonstrated a clinically significant improvement in adherence of 0.6 h/night (95% CI: -0.2 to 1.3 h/night) with nasal interface compared with oronasal interface (see supplemental material, Figure S96).”

    From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [244]

    The Abstract and RANDOMISED TRIAL section report higher nightly CPAP use with a nose mask than with a face mask in this four-week crossover trial. This paper reports a mean difference of 1.0 h/night (95% CI 0.3 to 1.8), not the cited pooled estimate of 0.6 h/night (95% CI −0.2 to 1.3) from three RCTs. Page numbers are not provided in the supplied passages. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Nasal masks yielded less sleepiness, as measured by lower ESS scores, than oronasal masks.

    “Comparisons of objective and subjective sleep quality and daytime sleepiness have demonstrated more slow wave and TST during CPAP titration using nasal masks compared to oronasal masks,1071 better sleep quality using CPAP with nasal masks compared to oronasal masks,1069 and less sleepiness (i.e., lower ESS scores) using nasal masks compared to oronasal masks.1068”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1068]

  • Some studies found significantly longer CPAP use with nasal masks than with oronasal masks.

    “While some studies have observed significantly longer durations of CPAP use with nasal masks compared to oronasal masks,1065,1068 others have found no significant differences.1063,1069”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1068]

  • Patients overall preferred nasal masks over oronasal masks.

    “Patients also expressed an overall preference for nasal masks compared to oronasal masks.1068,1069,1071”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1068]

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Research works printed but not linked: 4

  1. [4]4. Amato MBP, Barbas CSV, Medeiros DM, et al. Beneficial eVects of the "open lung approach" with low distending pressures in acute respiratory distress syndrome. Am J Respir Crit Care Med 1995;152:1835-46.
  2. [6]6. Bernard GR, Artigas A, Brigham KL, et al. The American European conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.
  3. [8]8. Montgomery AB, Stager MA, Carrico CJ, et al. Causes of mortality in patients with ARDS. Am Rev Respir Dis 1985; 132:485-9.
  4. [9]9. ACCP/Society of Critical Care Medicine Consensus Conference Committee. Definitions of sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644-55.

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Authors
Mortimore, I. L., Whittle, A. T., & Douglas, N. J.
Affiliations
Edinburgh Royal Infirmary (GB)
Corresponding author
Mortimore, I L
Venue
Thorax
Publisher
BMJ
Published
1998-04-01
Volume
53
Issue
4
Pages
290-292
ISSN
0040-6376 (ISSN-L)
DOI
10.1136/thx.53.4.290
PMC
PMC1745186
OpenAlex
W2168513641
Semantic Scholar
256379dda72c7baddde12f87b5cf8b6173e32918
Cited by
149
References
12
Citations by year
2026: 1 · 2025: 2 · 2024: 4 · 2023: 1 · 2022: 7 · 2021: 4 · 2020: 5 · 2019: 9 · 2018: 6 · 2017: 9 · 2016: 14 · 2015: 5 · 2014: 9 · 2013: 9 · 2012: 1
FWCI
1.84
Type
journal article
Language
en
Open access
Locations
  • Thorax (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Wellcome Trust
  • British Lung Foundation
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
sleep apnea, continuous positive airway pressure, nasal mask, face masks, CPAP adherence, uvulopalatopharyngoplasty, CPAP side effects, mask comfort, obstructive sleep apnea, CPAP titration
MeSH terms
Double-Blind Method, Face, Follow-Up Studies, Humans, Masks, Middle Aged, Nose, Patient Compliance, Positive-Pressure Respiration, Sleep Apnea Syndromes

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