Obstructive sleep apnoea and non-restorative sleep induced by the interface

Area of Science:

• Sleep Medicine
• Respiratory Physiology
• Medical Device Technology

Background:

• Limited data exist on how interfaces affect restorative sleep and CPAP/APAP levels in obstructive sleep apnoea (OSA) patients.
• Observations noted obstructive apnoeas with oro-nasal masks and non-restorative sleep despite normal respiratory disturbance index (RDI).

Purpose of the Study:

• To investigate the impact of different interfaces on sleep quality and positive airway pressure (PAP) requirements in OSA patients.
• To evaluate the effectiveness of nasal masks compared to oro-nasal masks in improving sleep parameters.

Main Methods:

• A cohort analysis was conducted from June 2006 to April 2014.
• Patients with OSA using oro-nasal masks who experienced normalized RDI after switching to nasal masks were included.
• Patients reporting non-restorative sleep despite a normal RDI under oro-nasal masks were also analyzed.

Main Results:

• Switching from oro-nasal to nasal masks normalized RDI and arousal index in 54 OSA patients (p < 0.001).
• Slow-wave and REM sleep increased significantly (p < 0.05) after interface change.
• PAP pressure requirements decreased in both pathological RDI (9.5 to 7.3 cm H2O, p < 0.001) and normal RDI (10.1 to 6.8 cm H2O, p < 0.01) groups.

Conclusions:

• Oro-nasal masks can paradoxically induce obstructive hypopnoeas or apnoeas.
• Clinicians should consider this phenomenon and prefer nasal masks for PAP therapy adaptation.
• Nasal masks are recommended even for patients who mouth breathe to ensure better sleep quality.