Equivalence of Nasal and Oronasal Masks during Initial CPAP Titration for Obstructive Sleep Apnea Syndrome
Open accessAbstract
STUDY OBJECTIVE: Continuous positive airway pressure (CPAP) titration studies are commonly performed using a nasal mask but some patients may prefer a full-face or oronasal mask. There is little evidence regarding the equivalence of different mask interfaces used to initiate treatment. We hypothesized that oronasal breathing when using an oronasal mask increases upper airway collapsibility and that a higher pressure may be required to maintain airway patency. We also assessed patient preferences for the 2 mask interfaces. DESIGN: Prospective, randomized, cross-over design with 2 consecutive CPAP titration nights. SETTING: Accredited laboratory in a university hospital. PATIENTS OR PARTICIPANTS: Twenty-four treatment-naive subjects with obstructive sleep apnea syndrome and respiratory disturbance index of greater than 15 events per hour. INTERVENTIONS: CPAP titration was performed using an auto-titrating machine with randomization to a nasal or oronasal mask, followed by a second titration night using the alternate mask style. MEASUREMENTS AND RESULTS: There was no significant difference in the mean pressures determined between nasal and oronasal masks, although 43% of subjects had nasal-to-oronasal mask-pressure differences of 2 cm H(2)O or more. Residual respiratory events, arousals, and measured leak were all greater with the oronasal mask. Seventy-nine percent of subjects preferred the nasal mask. CONCLUSIONS: Patients with obstructive sleep apnea syndrome can generally switch between nasal and oronasal masks without changing machine pressure, although there are individual differences that may be clinically significant. Measured leak is greater with the oronasal mask. Most patients with obstructive sleep apnea syndrome prefer a nasal mask as the interface for initiation of CPAP. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN: ACTRN12611000243910. URL: http://www.ANZCTR.org.au/ACTRN12611000243910.aspx
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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 [1071]
Another trial found no difference between oronasal and nasal masks in optimal CPAP pressures.
“Another found no difference between oronasal and nasal masks in optimal CPAP pressures.1071”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1071]
Nasal masks compared with oronasal masks during CPAP titration produced more slow wave sleep and total sleep time.
“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 [1071]
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Chan, A. S. L., & Lau, E. (2026) · Thorax · doi:10.1136/thorax-2025-224611
Overview of Obstructive Sleep Apnea
Goh, L. C., Shariff, M. A. M., Din, A. R. B. M., Wong, L. K., Ismail, A. S. M., Laavanya, R., Sebastin, E. R., Ismail, N. A. E., Wong, C. K., Ismail, A. I., et al. (2026) · Springer eBooks · doi:10.1007/978-981-95-9749-9_1
Optimizing Mask Selection for OSA Treatment With CPAP
Rosanelli, I., Hirata, R. P., Lorenzi‐Filho, G., & Genta, P. R. (2026) · CHEST Journal · doi:10.1016/j.chest.2026.07.5235
- Authors
- Teo, M., Amis, T., Lee, S., Falland, K., Lambert, S., & Wheatley, J.
- Affiliations
- Westmead Institute (AU)
- The University of Sydney (AU)
- Corresponding author
- Wheatley, John
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-07
- Volume
- 34
- Issue
- 7
- Pages
- 951-955
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC3119837
- OpenAlex
- W2010088155
- Semantic Scholar
- 7443a01a0510267e4210c270109076dbfd2fc0a6
- Cited by
- 87
- References
- 18
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 10 · 2018: 8 · 2017: 6 · 2016: 12 · 2015: 3 · 2014: 10 · 2013: 5 · 2012: 4
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- ResMed
- 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
- obstructive sleep apnea, CPAP titration, nasal mask, oronasal mask, full-face mask, auto-titrating CPAP, upper airway collapsibility, airway patency, mask leak, patient preferences, CPAP initiation
- MeSH terms
- Adult, Equipment Design, Female, Humans, Male, Masks, Middle Aged, Prospective Studies, Respiration, Cross-Over Studies, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure, Patient Preference
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