Positional Therapy – Is it Especially Helpful for Full Face CPAP Mask Patients?
Is Positional Therapy right for your patient who usually uses a full face CPAP mask?
One of the most important journals for sleep professionals is the Journal of Clinical Sleep Medicine (JCSM), the official journal of the American Academy of Sleep Medicine (AASM). This publication has been the go-to journal for sleep specialists who want to stay proficient in sleep medicine since 2005.
An interesting article in the March 2016 edition gives sleep technologists something else to consider when an oral nasal interface (full face mask) might need to be utilized. This article, “Body Position May Influence Oronasal CPAP Effectiveness to Treat OSA” presents a case study that caused the authors to develop a theory. The article acknowledges some things about full-face masks that are already well established though past studies (see references), which include that the nasal mask is the gold standard and that full-face masks have higher costs and are sometimes ineffective and are associated with higher leaks and higher AHI. Although these facts are already known, we also know that full-face masks are, nonetheless, a suitable choice for select patients.
Now we get to the new information!
This article presents a case report in which a person had severe OSA that was NOT positional. The patient was titrated twice, once on a full-face mask and once with a nasal mask. During the full-face mask titration, the patient was titrated to 16 cm, and during the nasal mask titration the patient was titrated to 7 cm/H2O.
Now, the difference in pressures needed with a full-face mask versus a nasal mask is not the point of this article…as stated earlier, this information is already well established in medical publications. Here’s what prompted the new theory: During the full face titration, pressure was constantly inadequate only in the supine position, while therapeutic pressure during the nasal titration was adequate in al positions.
Say what now? Why did the patient need more and more pressure in the supine position when the PSG showed OSA was NOT positional? The theory presented in this article indicates that the combination of the supine position and the way we already know full face masks can increase AHI cause the need for so much more pressure. As the title suggests, body position may be something to consider during a full-face mask titration even if the person’s OSA is not noted to be positional. Something to think about and look for!
The complete article is accessible to subscribers and AASM members. The abstract and a link to the complete article can be found here.
The references for the articles mentioned in this blog are:
Prosise GL, Berry RB. Oral-nasal continuous positive airway pressure as a treatment for obstructive sleep apnea. Chest. 1994;106:1803-3196.
Kaminska M, Montpetit A, Mathieu A, Jobin V, Morisson F, Mayer P. Higher effective oronasal versus nasal continuous positive airway pressure in obstructive sleep apnea: Effect of mandibular stabilization. Canadian Respiratory Journal : Journal of the Canadian Thoracic Society. 2014;21(4):234-238.
Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B, et al. (2013) Type of Mask May Impact on Continuous Positive Airway Pressure Adherence in Apneic Patients. PLoS ONE 8(5): e64382. doi:10.1371/journal.pone.0064382
Isono S, Tanaka A, Nishino T. Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea. Anesthesiology. 2002;97:780-5.
Liang Y, Kimball WR, Kacmarek RM, Zapol WM, Jiang Y. Nasal ventilation is more effective than combined oral-nasal ventilation during induction of general anesthesia in adult subjects. Anesthesiology. 2008;108:998-1000.
Want to learn more about alternative treatments that don't involve a CPAP mask? Read our article on alternatives to CPAP here.