CHEST Guidelines-The-High-Road,-the-Low-Road,-or-Both

The-High-Road,-the-Low-Road,-or-Both_chest

Pdf Summary

This editorial discusses the effectiveness of different routes of positive airway pressure (PAP) administration for treating obstructive sleep apnea (OSA). The standard approach for PAP has traditionally been through the nasal route due to safety considerations. However, oronasal and oral interfaces have also been developed for continuous PAP (CPAP) therapy. A study by Andrade et al. compared the effects of nasal, oronasal, and oral CPAP on airway stability. The study involved 18 obese adults with varying OSA severity, using a custom mask capable of delivering CPAP through nasal, oral, or combined routes. The results showed that while nasal CPAP achieved stable breathing, the same pressure through oronasal or oral routes often led to obstructive events and airway constriction. The study suggests that air delivered through both the nose and mouth might decrease air pressure efficiency in keeping the airway open, possibly requiring higher pressures for efficacy.<br /><br />The editorial advises that patients may need different pressure settings based on the type of mask (nasal, oronasal, or oral) they use, and an incorrect interface may compromise treatment efficacy. It stresses that initial adherence to CPAP therapy is crucial in the first week, and choosing a comfortable mask is key. It also highlights that PAP devices estimating apnea-hypopnea index (AHI) might not always be accurate, suggesting retitration or polysomnography if patients remain symptomatic after changing interfaces. Future research is recommended to explore variations in pressure requirements due to interface changes and their implications on treatment efficiency.

Keywords

positive airway pressure

obstructive sleep apnea

nasal CPAP

oronasal interface

oral CPAP

airway stability

treatment efficacy

mask type

pressure settings

polysomnography