Antoine Léotard1,2, Matthieu Lesgoirres3, Najeh Daabek1,3, Marius Lebret4,5, Sebastien Bailly1,2, Alain Verain2, Fréderic Series6, Jean-Louis Pépin1,2, Jean-Christian Borel1,3. 1. HP2, INSERM U1042, University Grenoble Alpes, F-38000, Grenoble, France. 2. Sleep and Exercise Laboratory, Thorax-Vaisseaux Department, Grenoble-Alpes University Hospital, Saint-Martin-d'Hères, France. 3. AGIR à dom. Association, 36 bd du Vieux Chêne, F-38240, Meylan, France. 4. HP2, INSERM U1042, University Grenoble Alpes, F-38000, Grenoble, France. mariuslebret@gmail.com. 5. AGIR à dom. Association, 36 bd du Vieux Chêne, F-38240, Meylan, France. mariuslebret@gmail.com. 6. Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) Université Laval, Québec, QC, G1V4G5, Canada.
Abstract
PURPOSE: Evidence for the management of CPAP-treated obstructive sleep apnea suggests that oronasal masks reduce mouth leaks at the expense of higher pressures and poorer adherence. Some authors have proposed the use of mandibular advancement devices in combination with nasal masks to address this. The aim of this study was to assess adherence to CPAP after 1 month's use of a nasal mask with a mandibular advancement device and to compare adherence with an oronasal mask. METHODS: A randomized crossover trial design to assess whether a mandibular advancement device combined with a nasal mask would improve CPAP adherence compared to an oronasal mask. RESULTS: There was no improvement in CPAP adherence and self-reported interface-related pain was significantly higher with the combined treatment. CONCLUSIONS: Although the combined treatment reduced pressures, likely by improving upper airway patency, it may only be appropriate for a small number of patients due to associated discomfort. TRIAL REGISTRATION: NCT01889472.
PURPOSE: Evidence for the management of CPAP-treated obstructive sleep apnea suggests that oronasal masks reduce mouth leaks at the expense of higher pressures and poorer adherence. Some authors have proposed the use of mandibular advancement devices in combination with nasal masks to address this. The aim of this study was to assess adherence to CPAP after 1 month's use of a nasal mask with a mandibular advancement device and to compare adherence with an oronasal mask. METHODS: A randomized crossover trial design to assess whether a mandibular advancement device combined with a nasal mask would improve CPAP adherence compared to an oronasal mask. RESULTS: There was no improvement in CPAP adherence and self-reported interface-related pain was significantly higher with the combined treatment. CONCLUSIONS: Although the combined treatment reduced pressures, likely by improving upper airway patency, it may only be appropriate for a small number of patients due to associated discomfort. TRIAL REGISTRATION: NCT01889472.
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