CHEST Guidelines-Sealing-the-Leak

Sealing-the-Leak_chest
Pdf Summary
Continuous positive airway pressure (CPAP) therapy is a standard treatment for obstructive sleep apnea (OSA). It operates through masks that can sometimes cause air leaks, impacting patient comfort and adherence to treatment. Intentional leaks, integral to the mask's design, are compensated by CPAP devices. However, unintentional leaks, which arise due to factors like an ill-fitting mask or mouth opening, are not well-defined and vary between manufacturers in terms of threshold and reporting. This lack of standardization has led to limited research on unintentional leaks despite their significance in patient adherence.<br /><br />Recent studies, like the one conducted by Lebret et al., have explored the factors influencing unintentional leaks. They recorded CPAP use in 74 patients, identifying that factors such as mouth opening, high CPAP levels, and REM sleep increase the likelihood of leaks. Although their findings shed light on mechanisms of air leaks, the clinical relevance of these findings is not yet fully understood. Notably, during REM sleep, oronasal CPAP demonstrated fewer leaks than nasal CPAP. A significant limitation in Lebret et al.'s study was their zero-threshold for defining leaks, whereas commercial thresholds suggest 24 or 36 L/min as a high leak depending on the mask type.<br /><br />Choosing between nasal and oronasal CPAP remains a clinical challenge. Nasal CPAP may be compromised by mouth breathing, while oronasal CPAP, often prescribed for this issue, has shown poorer outcomes and adherence. Paradoxically, Lebret et al.'s supervised lab study showed lower leaks with oronasal masks than previous studies suggested.<br /><br />Overall, understanding and managing unintentional leaks is crucial for tailoring CPAP treatment, improving adherence, and ultimately ensuring successful OSA management. This area of study highlights the need for more refined and standardized approaches to CPAP design, fitting, and leak management.
Keywords
CPAP therapy
obstructive sleep apnea
air leaks
patient adherence
unintentional leaks
nasal CPAP
oronasal CPAP
REM sleep
mask fitting
OSA management