Transmission of Oral Pressure Compromises Oronasal CPAP Efficacy in the Treatment of OSA
| Autor: | Fernanda Madeiro, Pedro R. Genta, VS Piccin, Rafaela G.S. Andrade, George do Lago Pinheiro, Geraldo Lorenzi-Filho, Henrique Takachi Moriya |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Positive pressure Nasal route Mouth breathing Polysomnography Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Pressure medicine Humans 030212 general & internal medicine Aged Mouth Sleep Apnea Obstructive Continuous Positive Airway Pressure medicine.diagnostic_test business.industry Mouth Breathing Middle Aged nervous system diseases respiratory tract diseases Catheter Treatment Outcome 030228 respiratory system Anesthesia Breathing Midazolam Female medicine.symptom Cardiology and Cardiovascular Medicine business Airway medicine.drug |
| Zdroj: | Chest. 156:1187-1194 |
| ISSN: | 0012-3692 |
| Popis: | An oronasal mask is frequently used to treat OSA. In contrast to nasal CPAP, the effectiveness of oronasal CPAP varies by unknown mechanisms. We hypothesized that oral breathing and pressure transmission through the mouth compromises oronasal CPAP efficacy.Thirteen patients with OSA, well adapted to oronasal CPAP, were monitored by full polysomnography, pharyngeal pressure catheter, and nasoendoscope. Patients slept with low doses of midazolam, using an oronasal mask with sealed nasal and oral compartments. CPAP was titrated during administration by the oronasal and nasal routes, and was then reduced to induce stable flow limitation and abruptly switched to the alternate route. In addition, tape sealing the mouth was used to block pressure transmission to the oral cavity.Best titrated CPAP was significantly higher by the oronasal route rather than the nasal route (P = .005), and patients with25% oral breathing (n = 5) failed to achieve stable breathing during oronasal CPAP. During stable flow limitation, inspiratory peak flow was lower, driving pressure was higher, upper airway inspiratory resistance was higher, and retropalatal and retroglossal area were smaller by the oronasal rather than nasal route (P .05 for all comparisons). Differences were observed even among patients with no oral flow and were abolished when tape sealing the mouth was used (n = 6).Oral breathing and transmission of positive pressure through the mouth compromise oronasal CPAP. |
| Databáze: | OpenAIRE |
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