1231 It Is All About the Mask

Abstract Introduction Positive airway pressure (PAP) therapy is the mainstay of treatment for adults with obstructive sleep apnea. One important factor for PAP therapy is choosing the optimal mask type. Multiple studies demonstrate a higher residual apnea-hypopnea index (AHI) and more leaks with the use of oronasal masks compared with nasal masks, yet oronasal masks are routinely chosen as the first-line option. Report of case(s) An 80-year-old man had a split polysomnogram with a diagnostic apnea-hypopnea index (AHI) 65.8/h, central apnea index (CAI) 0.4/h, and oxygen nadir 76%. During the study, on continuous positive airway pressure (CPAP) 10 cmH2O with an under-the-nose nasal mask, sleep-disordered breathing was resolved with a residual AHI of 0.7/h with supine REM sleep achieved. The patient was set up with CPAP 10 cmH2O; however, after 1 week of CPAP treatment, a notification indicated that his PAP-AHI was elevated in the 40s/h. After exploring several possible causes, we discovered that he was using an oronasal mask at home. A change to a nasal mask or pillows was recommended. While awaiting mask refit, he was also changed to auto-titrating PAP (APAP) settings of 10-20 cmH2O. PAP download data are as follows. On CPAP 10 cmH2O with an oronasal mask: 12/12 days used, 95th percentile leak 0.3 lpm, AHI 31.7/h (CAI 4.3/h). On APAP 10-20 cmH2O with an oronasal mask: 6/6 days used, median pressure 14.9 cmH2O, average maximum pressure 19.6 cmH2O, 95th percentile leak 0.0 lpm, AHI 26.0/h (CAI 3.6/h). On APAP 10-20 cmH2O with a nasal mask + chin strap: 45/45 days used, median pressure 10.4 cmH2O, average maximum pressure 12.5 cmH2O, 95th percentile leak 5.5 lpm, AHI 2.2/h. Average nightly use of PAP was >6 h at all assessments. Conclusion Individuals involved in PAP management, including providers, sleep technologists, and durable medical equipment groups, need to be aware that oronasal masks may not provide the same level of benefit as nasal masks or pillows. Additionally, the type of PAP mask used during in-laboratory PAP titration compared to home use is also of importance as therapeutic pressures may be largely different as demonstrated in this case. Support (if any)