Ahmed, Nayla

Purpose of review Mask choice is among the few modifiable determinants of positive airway pressure (PAP) effectiveness in adults with obstructive sleep apnea OSA), yet selection is often shaped by convention, habit, or local inventory rather than evidence. We review recent literature, emphasizing studies from the past 18 months and incorporating foundational mechanistic and outcomes studies that should influence prescribing choices. Recent findings Population-scale telemonitoring analyses confirm that nasal interfaces outperform oronasal masks on adherence, required pressure, residual apnea–hypopnea index (AHI), and unintentional leak. Switching patients from an oronasal to a nasal mask can increase adherence by up to 77%. Drug-induced sleep endoscopy with PAP, cine MRI, and sealed-compartment physiology suggest three main mechanisms for these observations: oral pressure transmission without oral airflow, posterior tongue and mandibular displacement, and increased pharyngeal collapsibility. Mandibular jaw-movement signals allow leak phenotyping that distinguishes mask-seal failure from mouth opening, supporting targeted intervention rather than reflexive interface change. Summary Current evidence supports a nasal-first prescribing strategy with structured early follow-up using telemonitored adherence, residual AHI, and leak waveform data. Oronasal masks should be reserved for documented and structured nasal-trial failure rather than selected on the basis of self-reported breathing route.

Abstract Introduction Bronchiectasis (BE) is characterized by recurrent infections and dilated airways and has been associated with recurrent exacerbations and hospitalizations affecting quality of life. Approximately 40-60% of patients with BE have concomitant OSA, with an increased AHI (apnea-hypopnea index) in BE patients with Pseudomonas infections. We hypothesize that patients with BE are less tolerant of PAP therapies, contributing to worsening quality of life related to either condition. We aim to determine differences in PAP adherence and treatment response in patients with BE and OSA compared with a matched OSA-control group. Methods A retrospective cohort analysis was conducted on adult patients evaluated at Mayo Clinic Center for Sleep Medicine between January 2000 to December 2020. Inclusion criteria were patients greater than 18 years old diagnosed with BE and OSA per current guidelines and were prescribed PAP therapy. Control OSA patients were matched to BE/OSA patients by gender, BMI, and AHI severity. Exclusion criteria included cystic fibrosis, hospice enrollment, active lung transplant evaluation, and lack of sleep clinic follow-up. Follow-up visits determined PAP compliance and change in quality-of-life metrics over 3 years. Results We compared 50 patients with BE/OSA with 74 OSA matched controls. The etiology of BE in these cases included COPD (32%) or other etiologies (34%). Baseline characteristics were not statistically different in gender, BMI, and AHI severity across groups. Median treatment follow-up for the BE/OSA group was 3 years [IQR 2 to 4]. Importantly, there was no statistically significant difference in PAP adherence in patients with BE/OSA compared to OSA controls regardless of etiology of BE, but these patients more often required supplemental oxygen therapy. Interestingly, there was a statistically significant increase in MRC and decrease in FEV1 over time in BE patients compliant to therapy. Conclusion There was no significant difference in baseline OSA characteristics, treatment response, and PAP adherence, except for need of oxygen supplementation in BE patients with OSA compared with matched non-BE OSA controls. FEV1 values decreased, and dyspnea score increased in BE patients compliant to PAP therapy; however, future larger studies should include longer-term follow-up to further assess the impact of PAP therapy on BE progression and outcomes. Support (if any)