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Comparison of the upper airway dynamics of oronasal and nasal masks with positive airway pressure treatment using cine magnetic resonance imaging

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Abstract

Purpose

It is known that oronasal masks are not as effective at opening the upper airway compared to nasal only continuous positive airway pressure (CPAP) masks in patients with sleep-disordered breathing. However, the physiological mechanism for this difference in efficacy is not known; although, it has been hypothesized to involve the retroglossal and/or retropalatal region of the upper airway. The objective of this study was to investigate differences in retroglossal and retropalatal anterior-posterior space with the use of oronasal vs. nasal CPAP masks using real-time cine magnetic resonance imaging (cMRI).

Methods

Ten subjects (eight men, two women) with obstructive sleep apnea (OSA) were given cMRI with both nasal and oronasal CPAP masks. Each subject was imaged with each interface at pressures of 5, 10, and 15 cm of H2O, while in the supine position along the sagittal plane.

Results

The oronasal mask produced significantly less airway opening in the retropalatal region of the upper airway compared to the nasal mask interface. During exhalation, mask style had a significant effect on anterior-posterior distance p = 0.016. No differences were found in the retroglossal region between mask styles.

Conclusions

Our study confirmed previous findings showing differences in treatment efficacy between oronasal and nasal mask styles. We have shown anatomic evidence that the nasal mask is more effective in opening the upper airway compared to the oronasal mask in the retropalatal region.

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References

  1. Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, Boehlecke B, Brown TM, Coleman J Jr, Friedman L, Kapen S, Kapur VK, Kramer M, Lee-Chiong T, Owens J, Pancer JP, Swick TJ, Wise MS (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3):375–380

    PubMed  Google Scholar 

  2. Jenkinson C, Davies RJ, Mullins R, Stradling JR (1999) Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 353(9170):2100–2105. doi:10.1016/S0140-6736(98)10532-9

    Article  CAS  PubMed  Google Scholar 

  3. Sin DD, Mayers I, Man GC, Ghahary A, Pawluk L (2002) Can continuous positive airway pressure therapy improve the general health status of patients with obstructive sleep apnea?: a clinical effectiveness study. Chest 122(5):1679–1685

    Article  PubMed  Google Scholar 

  4. Hui DS, Ko FW, Chan JK, To KW, Fok JP, Ngai JC, Chan MC, Tung A, Chan DP, Ho CW, Lai CK (2006) Sleep-disordered breathing and continuous positive airway pressure compliance in a group of commercial bus drivers in Hong Kong. Respirology 11(6):723–730. doi:10.1111/j.1440-1843.2006.00932.x

    Article  PubMed  Google Scholar 

  5. Kushida CA, Nichols DA, Holmes TH, Quan SF, Walsh JK, Gottlieb DJ, Simon RD Jr, Guilleminault C, White DP, Goodwin JL, Schweitzer PK, Leary EB, Hyde PR, Hirshkowitz M, Green S, McEvoy LK, Chan C, Gevins A, Kay GG, Bloch DA, Crabtree T, Dement WC (2012) Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 35(12):1593–1602. doi:10.5665/sleep.2226

    PubMed  PubMed Central  Google Scholar 

  6. Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, Roselle GA (1998) Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation 97(21):2154–2159

    Article  CAS  PubMed  Google Scholar 

  7. Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD (1999) Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 160(4):1101–1106. doi:10.1164/ajrccm.160.4.9903020

    Article  CAS  PubMed  Google Scholar 

  8. Sanner BM, Konermann M, Sturm A, Muller HJ, Zidek W (1997) Right ventricular dysfunction in patients with obstructive sleep apnoea syndrome. Eur Respir J 10(9):2079–2083

    Article  CAS  PubMed  Google Scholar 

  9. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353(19):2034–2041. doi:10.1056/NEJMoa043104

    Article  CAS  PubMed  Google Scholar 

  10. Thorpy M (2006) Obstructive sleep apnea syndrome is a risk factor for stroke. Curr Neurol Neurosci Rep 6(2):147–148

    Article  PubMed  Google Scholar 

  11. Kessler R, Chaouat A, Weitzenblum E, Oswald M, Ehrhart M, Apprill M, Krieger J (1996) Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences. Eur Respir J 9(4):787–794

    Article  CAS  PubMed  Google Scholar 

  12. Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R (1996) Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest 109(2):380–386

    Article  CAS  PubMed  Google Scholar 

  13. Sanner BM, Doberauer C, Konermann M, Sturm A, Zidek W (1997) Pulmonary hypertension in patients with obstructive sleep apnea syndrome. Arch Intern Med 157(21):2483–2487

    Article  CAS  PubMed  Google Scholar 

  14. Pepperell JC, Davies RJ, Stradling JR (2002) Systemic hypertension and obstructive sleep apnoea. Sleep Med Rev 6(3):157–173

    Article  PubMed  Google Scholar 

  15. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342(19):1378–1384. doi:10.1056/NEJM200005113421901

    Article  CAS  PubMed  Google Scholar 

  16. Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, Skatrud J (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 157(15):1746–1752

    Article  CAS  PubMed  Google Scholar 

  17. Nieto FJ, Peppard PE, Young T, Finn L, Hla KM, Farre R (2012) Sleep-disordered breathing and cancer mortality: results from the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med 186(2):190–194

    Article  PubMed  PubMed Central  Google Scholar 

  18. Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O’Connor GT, Rapoport DM, Redline S, Resnick HE, Robbins JA, Shahar E, Unruh ML, Samet JM (2009) Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 6(8), e1000132

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kuna ST, Remmers JE (1985) Neural and anatomic factors related to upper airway occlusion during sleep. Med Clin N Am 69(6):1221–1242

    CAS  PubMed  Google Scholar 

  20. Sanders MH, Kern NB, Stiller RA, Strollo PJ Jr, Martin TJ, Atwood CW Jr (1994) CPAP therapy via oronasal mask for obstructive sleep apnea. Chest 106(3):774–779

    Article  CAS  PubMed  Google Scholar 

  21. Smith PL, Wise RA, Gold AR, Schwartz AR, Permutt S (1988) Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 64(2):789–795

    CAS  PubMed  Google Scholar 

  22. Prosise GL, Berry RB (1994) Oral-nasal continuous positive airway pressure as a treatment for obstructive sleep apnea. Chest 106(1):180–186

    Article  CAS  PubMed  Google Scholar 

  23. Teo M, Amis T, Lee S, Falland K, Lambert S, Wheatley J (2011) Equivalence of nasal and oronasal masks during initial CPAP titration for obstructive sleep apnea syndrome. Sleep 34(7):951–955

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bakker JP, Neill AM, Campbell AJ (2011) Nasal versus oronasal continuous positive airway pressure masks for obstructive sleep apnea: a pilot investigation of pressure requirement, residual disease, and leak. Sleep & breathing = Schlaf & Atmung

  25. Ebben MR, Oyegbile T, Pollak CP (2012) The efficacy of three different mask styles on a PAP titration night. Sleep Med 13(6):645–649

    Article  PubMed  Google Scholar 

  26. Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B, Grillet Y, Muir JF, Levy P, Series F (2013) Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One 8(5), e64382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Ebben MR, Narizhnaya M, Segal AZ, Barone D, Krieger AC (2014) A randomised controlled trial on the effect of mask choice on residual respiratory events with continuous positive airway pressure treatment. Sleep Med 15(6):619–624. doi:10.1016/j.sleep.2014.01.011

    Article  PubMed  Google Scholar 

  28. Armstrong JJ, Leigh MS, Sampson DD, Walsh JH, Hillman DR, Eastwood PR (2006) Quantitative upper airway imaging with anatomic optical coherence tomography. Am J Respir Crit Care Med 173(2):226–233. doi:10.1164/rccm.200507-1148OC

    Article  PubMed  Google Scholar 

  29. Horner RL, Shea SA, McIvor J, Guz A (1989) Pharyngeal size and shape during wakefulness and sleep in patients with obstructive sleep apnoea. Q J Med 72(268):719–735

    CAS  PubMed  Google Scholar 

  30. Schwab RJ, Pasirstein M, Kaplan L, Pierson R, Mackley A, Hachadoorian R, Arens R, Maislin G, Pack AI (2006) Family aggregation of upper airway soft tissue structures in normal subjects and patients with sleep apnea. Am J Respir Crit Care Med 173(4):453–463. doi:10.1164/rccm.200412-1736OC

    Article  PubMed  PubMed Central  Google Scholar 

  31. Morrell MJ, Arabi Y, Zahn B, Badr MS (1998) Progressive retropalatal narrowing preceding obstructive apnea. Am J Respir Crit Care Med 158(6):1974–1981. doi:10.1164/ajrccm.158.6.9712107

    Article  CAS  PubMed  Google Scholar 

  32. Bhattacharyya N, Blake SP, Fried MP (2000) Assessment of the airway in obstructive sleep apnea syndrome with 3-dimensional airway computed tomography. Otolaryngol–Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 123(4):444–449. doi:10.1067/mhn.2000.109367

    Article  CAS  Google Scholar 

  33. Schwab RJ, Gefter WB, Pack AI, Hoffman EA (1993) Dynamic imaging of the upper airway during respiration in normal subjects. J Appl Physiol 74(4):1504–1514

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Support provided by the National Institutes of Health—National Center for Advancing Translational Sciences, Grant # UL1 TR000457-06

Financial disclosures

The authors of this study have no financial disclosures.

Conflicts of interest

None

Author contribution

Matthew R. Ebben was involved with all aspects of this study and agrees to be accountable for all aspects of this work.

Sara Milrad contributed to acquisition and analysis of data, revised the manuscript for intellectual content, and approved the final version of the manuscript and agrees to be accountable for all aspects of this work.

Jonathan P. Dyke contributed to acquisition and analysis of data, revised the manuscript for intellectual content, and approved the final version of the manuscript and agrees to be accountable for all aspects of this work.

C. Douglas Phillips contributed to conception and design of the study, revised the manuscript for intellectual content, and approved the final version of the manuscript and agrees to be accountable for all aspects of this work.

Ana C. Krieger contributed to conception and design of the study, revised the manuscript for intellectual content, and approved the final version of the manuscript and agrees to be accountable for all aspects of this work.

Author information

Authors and Affiliations

  1. Department of Neurology, Weill Cornell Medical College, New York, NY, USA

    Matthew R. Ebben & Ana C. Krieger

  2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Sara Milrad & Ana C. Krieger

  3. Department of Radiology, Weill Cornell Medical College, New York, NY, USA

    Jonathan P. Dyke & C. Douglas Phillips

  4. Center for Sleep Medicine, Weill Cornell Medical College, 425 East 61st Street, 5th Floor, New York, NY, 10065, USA

    Matthew R. Ebben

Authors
  1. Matthew R. Ebben
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  2. Sara Milrad
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  5. Ana C. Krieger
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Corresponding author

Correspondence to Matthew R. Ebben.

Additional information

This study was registered on Clinicaltrials.gov on August 13, 2013 (#NCT01939938)

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Ebben, M.R., Milrad, S., Dyke, J.P. et al. Comparison of the upper airway dynamics of oronasal and nasal masks with positive airway pressure treatment using cine magnetic resonance imaging. Sleep Breath 20, 79–85 (2016). https://doi.org/10.1007/s11325-015-1187-x

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  • DOI: https://doi.org/10.1007/s11325-015-1187-x

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