Mask type and CPAP treatment effectiveness

Are you on CPAP treatment? Which type of mask do you use? Likely, when you were first diagnosed and prescribed to CPAP treatment, you were given a choice of different types of masks. There are nasal masks, which simply cover the nose. There are nasal pillows, which basically only cover the nostrils. There are oral masks, which only cover the mouth (these are for those who only breathe out of their mouths, obviously). And there are oronasal masks that cover both the nose and mouth. (If you want to see what these look like, you could benefit from a quick Google search.) The most commonly used masks are nasal, nasal pillows, and oronasal. But do these masks differ in terms of effectiveness? Recently a group of researchers did a meta-analysis, meaning they combined and analyzed existing published results, to see whether effectiveness differs. They also analyzed treatment adherence, which is basically just how well people stick to their treatment.

Effectiveness of different types of masks was examined by grouping together the results of 4 studies. By combining these studies, the researchers were able to have a sample size of over 2,500, which is very large! It was found that the residual AHI, which is the number of apneas and hypopneas that are still present when an individual is being treated with CPAP, was higher for those using the oronasal mask, when compared with just the nasal mask. Additionally, when those who were originally using a nasal mask were switched to an oronasal mask, their residual AHI increased. It seems, then, that the oronasal mask is less effective than the nasal mask. Importantly, the nasal mask and the nasal pillows seemed to be equally effective.

In order to test whether each type of mask had an impact on CPAP adherence, the data from 8 studies were gathered. The results were very consistent with the effectiveness results, as more research participants who were using an oronasal mask stopped treatment than those who were wearing a nasal mask. It also seemed that the nasal pillows had a slightly better adherence rate than the nasal masks. However, those using the nasal pillows reported more symptoms of nasal congestion, nasal dryness, nosebleeds, and headaches than did those using the nasal mask. 

This is a very important study, as it shows that a seemingly simple decision – which mask should I pick? – can affect how well CPAP treatment works and whether an individual will stick to the treatment. If you are someone who uses an oronasal mask and you have difficulties using or adhering to treatment, you may benefit from trying out a nasal mask or a nasal pillow mask. If someone you know uses an oronasal mask, you might suggest the same thing. However, it is important to remember that some people do find the oronasal mask more comfortable, so switching masks should only be something that is considered if treatment is uncomfortable or difficult.

de Andrade, R. G. S., Piccin, V. S., Nascimento, J. A., Viana, F. M. L., Genta, P. R., & Lorenzi-Filho, G. (2014). Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea. J Bras Pneumol, 40(6), 658-668.

Janna Mantua


Janna is a PhD Student / Graduate Research Assistant at University of Massachusetts Amherst with a background in clinical sleep research and psychology. Janna Mantua is a PhD student in the Behavioral Neuroscience department at the University of Massachusetts. Her research focuses on sleep and aging, with specific projects on cognitive health, inflammation, memory formation, and neuroimaging. Prior to her PhD work, Janna was involved in research on sleep apnea and cognitive decline at the NYU Sleep Disorders Center.

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