1102 Treatment Failure Related to Change of Mask Interface in a Patient with Chronic Respiratory Failure and Obstructive Sleep Apnea. (27th April 2018)

• Record Type: Journal Article
• Authors: Negatu, Yihenew; Das, Aneesa
• Is Part Of: Sleep. Volume 41(2018)Supplement 1
• Page Start: A409
• Page End: A410
• Publication Date: 2018-04-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy063.1101
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Non-invasive ventilation is widely used for the management of patients with respiratory failure during sleep using various mask interfaces. In practice, it is common to switch masks after PAP titration. The potential impact of switching masks on treatment outcome is not well defined in literature. Report of Case: A 50 year old woman with chronic respiratory failure requiring supplemental oxygen, restrictive thoracic disease secondary to scoliosis, mild obstructive sleep apnea(OSA) (AHI 10 events/hr) and resultant pulmonary hypertension was referred to our sleep clinic. CPAP titration was ineffective. Bilevel titration showed control of obstructive events and desaturations with IPAP of 12 cmH2O and EPAP of 6 cmH2O along with oxygen at 2LPM. On her first visit with us, she complained of mouth leak while using a nasal pillow mask that was confirmed on the device download. The nasal pillow was changed to an oronasal mask. Over 4 months, her bilevel settings and oxygen were increased to bilevel 14/6 and 4LPM due to significant oxygen desaturations and residual AHI. A detailed examination of her downloaded data revealed a temporal correlation of the worsening of AHI and new desaturations with change of her mask interface despite improvement in mouth leak. Resuming the nasal pillow interface yielded improvement in symptoms, AHI, and bilevel and oxygen requirements despite return of the mouth air leak. Bilevel with a nasal pillow interface was more effective at treating her chronic respiratory failure and OSA than a full face mask even with significant air leakage through the mouth. Several studies have shown that oronasal masks require higher effective pressures or can be associated with a higher residual AHI. Conclusion: Changing masks after a titration can be a cause of treatment failure. Hence close monitoring of symptoms and download data is required following switch of mask interface.