Type of mask may impact on continuous positive airway pressure adherence in apneic patients

PLoS One. 2013 May 15;8(5):e64382. doi: 10.1371/journal.pone.0064382. Print 2013.


Rationale: In obstructive sleep apnea patients (OSA), continuous positive airway pressure (CPAP) adherence is crucial to improve symptoms and cardiometabolic outcomes. The choice of mask may influence CPAP adherence but this issue has never been addressed properly.

Objective: To evaluate the impact of nasal pillows, nasal and oronasal masks on CPAP adherence in a cohort of OSA.

Methods: Newly CPAP treated OSA participating in "Observatoire Sommeil de la Fédération de Pneumologie", a French national prospective cohort, were included between March 2009 and December 2011. Anthropometric data, medical history, OSA severity, sleepiness, depressive status, treatment modalities (auto-CPAP versus fixed pressure, pressure level, interface type, use of humidifiers) and CPAP-related side effects were included in multivariate analysis to determine independent variables associated with CPAP adherence.

Results: 2311 OSA (age = 57(12) years, apnea+hypopnea index = 41(21)/h, 29% female) were included. Nasal masks, oronasal masks and nasal pillows were used by 62.4, 26.2 and 11.4% of the patients, respectively. In univariate analysis, oronasal masks and nasal pillows were associated with higher risk of CPAP non-adherence. CPAP non-adherence was also associated with younger age, female gender, mild OSA, gastroesophageal reflux, depression status, low effective pressure and CPAP-related side effects. In multivariate analysis, CPAP non-adherence was associated with the use of oronasal masks (OR = 2.0; 95%CI = 1.6; 2.5), depression, low effective pressure, and side effects.

Conclusion: As oronasal masks negatively impact on CPAP adherence, a nasal mask should be preferred as the first option. Patients on oronasal masks should be carefully followed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Continuous Positive Airway Pressure / instrumentation*
  • Female
  • Humans
  • Male
  • Masks*
  • Middle Aged
  • Patient Compliance*
  • Prospective Studies
  • Sleep Apnea, Obstructive / therapy*

Grant support

The Sleep Registry of the French Federation of Pneumology, (FFP); La Haute Autorité de Santé (HAS), Direction Générale de la Santé (DGS); L’Association Nationale pour le Traitement à Domicile de l’Insuffisance Respiratoire (ANTADIR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.