Oronasal Masks Require a Higher Pressure than Nasal and Nasal Pillow Masks for the Treatment of Obstructive Sleep Apnea
Open accessAbstract
Study objectives Oronasal masks are frequently used for continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). The aim of this study was to (1) determine if CPAP requirements are higher for oronasal masks compared to nasal mask interfaces and (2) assess whether polysomnography and patient characteristics differed among mask preference groups.Methods Retrospective analysis of all CPAP implementation polysomnograms between July 2013 and June 2014. Prescribed CPAP level, polysomnography results and patient data were compared according to mask type (n = 358).Results Oronasal masks were used in 46%, nasal masks in 35% and nasal pillow masks in 19%. There was no difference according to mask type for baseline apnea-hypopnea index (AHI), body mass index (BMI), waist or neck circumference. CPAP level was higher for oronasal masks, 12 (10-15.5) cm H2O compared to nasal pillow masks, 11 (8-12.5) cm H2O and nasal masks, 10 (8-12) cm H2O, p < 0.0001 (Median [interquartile range]). Oronasal mask type, AHI, age, and BMI were independent predictors of a higher CPAP pressure (p < 0.0005, adjusted R(2) = 0.26.). For patients with CPAP ≥ 15 cm H2O, there was an odds ratio of 4.5 (95% CI 2.5-8.0) for having an oronasal compared to a nasal or nasal pillow mask. Residual median AHI was higher for oronasal masks (11.3 events/h) than for nasal masks (6.4 events/h) and nasal pillows (6.7 events/h), p < 0.001.Conclusions Compared to nasal mask types, oronasal masks are associated with higher CPAP pressures (particularly pressures ≥ 15 cm H2O) and a higher residual AHI. Further evaluation with a randomized control trial is required to definitively establish the effect of mask type on pressure requirements.Commentary A commentary on this article appears in this issue on page 1209.
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Two other studies observed higher residual AHI with oronasal mask use compared to nasal masks and/or nasal pillows.
“Two other studies have observed that effective CPAP pressure and residual AHI were higher with oronasal mask use compared to nasal masks1074 and/or nasal pillows.1075”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1075]
Experimental — accuracy not yet measuredTwo other studies observed higher effective CPAP pressure with oronasal mask use compared to nasal masks and/or nasal pillows.
“Two other studies have observed that effective CPAP pressure and residual AHI were higher with oronasal mask use compared to nasal masks1074 and/or nasal pillows.1075”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1075]
Equations combining anthropomorphic and OSA severity variables differ from manually determined pressures by up to 5 cmH2O.
“Although these equations may provide a starting pressure for titration, their use as the sole determinant of a patient’s therapeutic pressure has not been accepted as they differ from manually determined pressures by up to 5 cmH2O.1075,1086,1087”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1075]
The Statistical Analysis section (pp. 2–3) describes a regression using patient characteristics and OSA severity to predict prescribed CPAP pressure. The Discussion (p. 4) addresses mask type as a predictor, but neither section compares equation-derived pressures with manually determined pressures or reports a difference of up to 5 cm H2O. Searched for prediction equations, manual titration, and the 5 cm H2O difference. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Deshpande, S., Joosten, S., Turton, A., Edwards, B. A., Landry, S., Mansfield, D. R., & Hamilton, G. S.
- Affiliations
- Monash Health (AU)
- Monash University (AU)
- ORCID
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2016-09-15
- Volume
- 12
- Issue
- 9
- Pages
- 1263-1268
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC4990949
- OpenAlex
- W2520064914
- Semantic Scholar
- 7deb8ed651620d32dbe98769cc8907e9a702fc9f
- Cited by
- 61
- References
- 22
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 7 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 8 · 2019: 8 · 2018: 4 · 2017: 6 · 2016: 1 · 2015: 1
- FWCI
- 5.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- oronasal mask, nasal mask, obstructive sleep apnea, mask types, apnea-hypopnea index, CPAP titration, polysomnography
- MeSH terms
- Australia, Equipment Design, Female, Humans, Male, Masks, Middle Aged, Nose, Pressure, Retrospective Studies, Treatment Outcome, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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