Impact of CPAP interface and mandibular advancement device on upper airway mechanical properties assessed with phrenic nerve stimulation in sleep apnea patients

Oronasal mask (ONM) can be used when mouth leaks impair nasal-CPAP effectiveness. However, ONM's constraint on the chin and straps’ traction may alter upper airway (UA) mechanical properties. In contrast, mandibular advancement device associated with nasal-CPAP (NM + MAD) may reduce UA resistance. The aim of this exploratory study was to compare the effects of ONM, NM, and NM + MAD on UA mechanical properties. The three interface modalities were assessed in 11 OSAS patients at 6, 8, 10 cmH2O CPAP using a phrenic nerve magnetic stimulation (PNMS) protocol. PNMS-twitches’ related flow, pharyngeal pressures (nasopharynx, velopharynx, oropharynx) and UA resistances were determined. Regardless of CPAP level, twitch-induced maximum flow was higher with NM + MAD than with ONM. Velopharyngeal resistance was higher with ONM than with NM + MAD. Oropharyngeal resistance was higher with ONM than with NM. In conclusion, NM + MAD reduced velopharyngeal resistance compared to those measured with ONM and NM alone. We hypothesize that this strategy may help reducing the effective pressure level and thus further limit the risk for mouth leaks.

► CPAP interface interacts with upper airway mechanical properties.
► Oro-nasal mask increase upper airway resistance compared to nasal mask.
► The beneficial effects of CPAP therapy on upper airway load is influenced by CPAP interface in association with mandibular advancement device.