Order 1629719: How controlled is Obstructive Sleep Apnea with the use of Nasal mask?
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2SEVEREOBSTRUCTIVESLEEPAPNEAANDTHEUSEOFNASALMASK2.docxHOW CONTROLLED IS OBSTRUCTIVE SLEEP APNEA WITH THE USE
OF NASAL / PILLOW MASK?
INVESTIGATION
When people sleep, the neck muscles relax to the extent that the upper airway closes partially and become narrow, this causes disruption to the air way passage (ResMed, 2019). This narrowing of the airway brings about vibration in the throat when breathing, which causes the sound of snoring. The relaxation of the neck muscles can occur due to many reasons. From swollen tonsils to too much of alcohol, being overweight and most especially the shape of the nose and the jaw- to mention few of the factors that could cause the neck muscles to relax and causes snoring (ResMed, 2019). This situation leads to a condition known as Obstructive Sleep Apnea.
According to British Lung Foundation (2014), Obstructive Sleep Apnoea (OSA) is a sleep-related respiratory condition that causes repeated temporary cessations of breathing occur during sleep, as a of a narrowing or closing of the pharyngeal airway in sleep. (NHS, 2016) describes Obstructive sleep apnoea (OSA) as a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing, while the Central Apnea occurs when the body fails to make attempt to breathe during pauses If OSA is not treated, it deprives people of a healthy sleep, which can cause severe daytime sleepiness (Carlos Rejón Parrilla, et al. 2014). British Snoring & Sleep Apnoea Association (2018) explain that, these periods of 'stopping breathing' only become clinically significant if the stopping lasts for more than 10 seconds each time and occur more than 5 times every hour. 1.5million adult is estimated to be experiencing Obstructive Sleep Apnea in UK, and only around 330,000 are currently diagnosed and treated. (BBC NEWS UK, 2017). It is linked to increased cardiovascular, motor vehicle, and other accident risk, lower workplace productivity, and increased health care expenditure in comparison with the normal population (Rowland, et al. 2018).
Investigation shows that Obstructive Sleep apnea (OSA) patients prefer the pillow/nasal mask. Even though, some of these patients still have complain about their sleep (Rowland, et al. 2018). It has been observed that in some patients the symptoms of tiredness and sleepiness come back after a while, hence investigation of why and how commenced. Research has proved the direct health benefits that effective treatment of OSA can generate. Guest et al. (2008), estimated that CPAP usage for a given time of 14 years could save the NHS close to £1,000 per patient.
What is CPAP?
Continuous positive airway pressure (CPAP) is a type of treatment that has shown effective for sleep apnea. Even though it is effective, compliance with this therapy continues to be problematic. In fact, up to 83% of patients don't comply with CPAP therapy (Brooks, 2017). Studies explained that for treatment to be effective the right respiration pressure and a mask that fits perfectly has to be in chosen. While the average CPAP usage is around five to six hours a night, many patients use it fewer than four hours a night. As long-term plans of CPAP usage are often proved in the first few days (Brooks, 2017). Brooks 2017 clarified further that, it is necessary to find a mask that is acceptable to the patient, seals comfortably, and is linked with minimal side effects. This will surely boost the patient adherence.
Types of Mask
The Journal of Clinical Sleep Medicine Article (Rowland, et al 2018), explain there are many types of masks for CPAP patients to choose from. The Full-Face Masks also called Oronasal mask, which covers both the mouth and nose and allows the patient to breathe through nose and mouth as seen in fig. 1 and 2.
Fig 1 Fig.2
The Full-Face Mask (from ResMed.) Patient with Full-Face mask in Bed
Another type of mask is known as Nasal mask this cover only the nose, and can be describe as small plastic with soft silicone that rest on the nose bridge for easy grip and comfort as shown in Fig. 3 and 4.
Fig. 3 Nasal Mask Fig 4 Nasal Mask in use
Last mask to mention is the Nasal pillow mask, which seat in the nose exclusively. Nasal pillow mask has been known to be in popular request by OSA patients, it is compact and lightweight option for patient with designs that allow minimal contact with their face. Nevertheless, side effects have been reported in more than 50% of patient in some studies (Rowland, et al. 2018). Example of Nasal Pillow Mask is shown in Figure 5.
Fig. 5 Nasal mask in use Fig. 6. Nasal Pillow (under nose)
Patient compliance
Size, fit, and comfort are essential considerations when choosing a CPAP mask. It's not likely to be compliant with CPAP therapy, If the mask doesn't fit, isn't comfortable, or doesn't meet breathing needs. Hence, the purpose will be jeopardised. A right choice of CPAP mask leads to successful therapy, which is quality of sleep and good health. This can always be measure by checking Epworth sleepiness score (ESS). The ESS requests the patient to rate themselves on a 4-point scale (0-3) their usual chances of having dozed off or fallen asleep while engaged in eight different activities (Johns, 1994; 2010).
Mador et al. (2005), estimated that 70% of CPAP users do experience nose and nasal dryness as well as nasal congestion, these situations contributes to non-compliance of patients. Humidifier is usually introduced to CPAP therapy for patient’s comfort to moisturise the air patient breathes and prevents nasal resistance which causes mouth breathing. Thus, humidification reduces nasal congestion and throat dryness and improve compliance of patients by adding warmness and moistness.
According to British Thorax Society Journal.
References
Brook, R. (2017) Which CPAP Mask is Best for your Patient? Pros & Cons of Various Mask Types. Available at: https://www.aastweb.org/blog/cpap-masks-options-full-face-nasa-and-nasal-pillows (Accessed: 02 January 2019).
Carlos Rejón Parrilla - J. Garau M. and Sussex J. (2014) Obstructive Sleep Apnoea Health Economics Report [Online] Available at: https://www.blf.org.uk/sites/default/files/OHE-OSA-health-economics-report---FINAL---v2.pdf (Accessed 26 December 2018).
Guest, J. F., Helter, M. T., Morga, A., & Stradling, J. R. (2008). Cost-effectiveness of using continuous positive airway pressure in the treatment of severe obstructive sleep apnoea/hypopnoea syndrome in the UK. Thorax, 63(10), pp.860-865.
Rowland, S., Alyappan, V., Hennessy, C., Catcheside, P., Li, C., McEvoy, R., and Antic N. (2018) Comparing the Efficacy, Mask Leak, Patient Adherence, and Patient Preference of Three Different CPAP Interfaces to Treat Moderate-Severe Obstructive Sleep Apnea . Journal of Clinical Sleep Medicine. 15 January, 14(1) (12), pp. 101-108.
