Comment choisir l'interface au cours du traitement du syndrome d'apnées obstructives du sommeil par pression positive continue

Continuous positive airway pressure (CPAP) is the first line therapy for moderate to severe obstructive sleep apnea syndrome (OSAS). In spite of technical innovations regarding the masks, more than 50% of the patients exhibit adverse effects and particularly non-intentional leaks. In this context, the choice of the right interface is crucial. Few studies have assessed the effects of different interfaces on upper airway mechanical properties, CPAP efficacy and compliance. Indeed, only one Cochrane review, including four studies and 132 patients, concluded that the optimum type of interface remained unclear but nasal mask should be considered as the first line interface. Recent studies have addressed this problem of interfaces and give new clinical and physiological insights for helping clinicians in the choice of mask: Functional and/or anatomical problems that increase nasal resistances have to be assessed and treated when possible. If there are no such problems, a nasal mask is the first option to initiate CPAP. Nasal pillows give the opportunity to reduce mask size in case of cutaneous problems or ocular irritation. Finally, oronasal masks are proposed as an alternative to respond to sleep-related mouth leaks that reduce CPAP efficacy or tolerance. However, patients on oronasal mask should be carefully followed.