Transmission of Oral Pressure Compromises Oronasal CPAP Efficacy in the Treatment of OSA
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Citações na Scopus
12
Tipo de produção
article
Data de publicação
2019
Título da Revista
ISSN da Revista
Título do Volume
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ELSEVIER
Autores
ANDRADE, Rafaela G. S.
PICCIN, Vivien S.
MORIYA, Henrique T.
Citação
CHEST, v.156, n.6, p.1187-1194, 2019
Resumo
BACKGROUND: 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. METHODS: 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. RESULT: Best titrated CPAP was significantly higher by the oronasal route rather than the nasal route (P = .005), and patients with > 25% 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). CONCLUSION: Oral breathing and transmission of positive pressure through the mouth compromise oronasal CPAP.
Palavras-chave
CPAP, mouth breathing, oronasal mask, OSA
Referências
- Andrade RGS, 2018, CHEST, V153, P665, DOI 10.1016/j.chest.2017.10.044
- Andrade RGS, 2016, CHEST, V150, P1194, DOI 10.1016/j.chest.2016.04.017
- Bachour A, 2004, CHEST, V126, P1248, DOI 10.1378/chest.126.4.1248
- Bettinzoli M, 2014, SLEEP BREATH, V18, P845, DOI 10.1007/s11325-014-0954-4
- Borel JC, 2012, RESP PHYSIOL NEUROBI, V183, P170, DOI 10.1016/j.resp.2012.06.018
- COTTLE MH, 1958, ARCHIV OTOLARYNGOL, V68, P301
- Deshpande S, 2016, J CLIN SLEEP MED, V12, P1263, DOI 10.5664/jcsm.6128
- Ebben MR, 2014, SLEEP MED, V15, P619, DOI 10.1016/j.sleep.2014.01.011
- Ebben MR, 2012, SLEEP MED, V13, P645, DOI 10.1016/j.sleep.2012.02.004
- Flemons WW, 1999, SLEEP, V22, P667
- Genta PR, 2011, J APPL PHYSIOL, V111, P1315, DOI 10.1152/japplphysiol.00508.2011
- Goh KJ, 2019, RESPIROLOGY, V24, P278, DOI 10.1111/resp.13396
- Kaminska M, 2014, CAN RESPIR J, V21, P234, DOI 10.1155/2014/408073
- Lorenzi Filho Geraldo, 2010, J. bras. pneumol., V36, P38, DOI 10.1590/S1806-37132010001400011
- Nascimento JA, 2016, J CLIN SLEEP MED, V12, P447, DOI 10.5664/jcsm.5602
- Ng JR., 2016, J CLIN SLEEP MED, V12, P11227
- Peppard PE, 2013, AM J EPIDEMIOL, V177, P1006, DOI 10.1093/aje/kws342
- PROSISE GL, 1994, CHEST, V106, P180, DOI 10.1378/chest.106.1.180
- Ravesloot MJL, 2011, LARYNGOSCOPE, V121, P2710, DOI 10.1002/lary.22369
- Ruhle KH, 2008, RESPIRATION, V76, P40, DOI 10.1159/000111806
- SANDERS MH, 1994, CHEST, V106, P774, DOI 10.1378/chest.106.3.774
- Andrade RGS, 2016, CURR OPIN PULM MED, V22, P555, DOI 10.1097/MCP.0000000000000318
- de Andrade RGS, 2014, J BRAS PNEUMOL, V40, P658, DOI 10.1590/S1806-37132014000600010
- Schellhas V, 2018, SLEEP BREATH, V22, P781, DOI 10.1007/s11325-018-1640-8
- Schorr F, 2012, EUR RESPIR J, V40, P503, DOI 10.1183/09031936.00145111
- Senny F., 2012, OPEN SLEEP J, V5, P1
- Shirlaw T, 2019, J SLEEP RES, V28, DOI 10.1111/jsr.12760
- SMITH PL, 1988, J APPL PHYSIOL, V64, P789
- SULLIVAN CE, 1981, LANCET, V1, P862
- Tufik S, 2010, SLEEP MED, V11, P441, DOI 10.1016/j.sleep.2009.10.005
- Vroegop AV, 2014, LARYNGOSCOPE, V124, P797, DOI 10.1002/lary.24479
- Westhoff M, 2015, SLEEP BREATH, V19, P1317, DOI 10.1007/s11325-015-1173-3
- Young T, 2002, AM J RESP CRIT CARE, V165, P1217, DOI 10.1164/rccm.2109080