Side Effects of Nasal Continuous Positive Airway Pressure in Sleep Apnea Syndrome: Study of 193 Patients in Two French Sleep Centers

doi:10.1378/chest.107.2.375

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Volume 107, Issue 2, February 1995, Pages 375-381

https://doi.org/10.1378/chest.107.2.375 Get rights and content

Nasal continuous positive airway pressure (N-CPAP) is now the treatment of choice for patients with sleep apnea syndrome (SAS). Side effects and adverse reactions have been described with this device. We have therefore systematically studied side effects of N-CPAP in 193 patients recruited consecutively from two French sleep centers (Lyon and Grenoble). Patients were followed up with repeated polysomnography, clinical assessment, and a formal questionnaire about subjective benefits and side effects of treatment. The patients (mean age, 59±12 years) were obese (body mass index, 32±7 kg/m²) and had been using N-CPAP for 19±17 months for moderate to severe SAS (respiratory disturbance index [RDI] =53±25/h). The clinical presentation was the same in the two sleep centers. Fifty percent of the patients complained of at least one side effect due to the nasal mask (allergy to the face, air leaks, abrasions of the ridge of the nose). Using individually molded masks, the patients exhibited fewer abrasions of the bridge of the nose (p<0.01) and had red eyes every morning in only 9% of cases vs 24% for the patients using industrial silicone nasal masks (p<0.025). Patients with silicone nasal masks also had more allergic reaction to the face (13% vs 5%), but this difference did not reach significance. Dry nose or mouth in the morning affected 65% of the patients. Sneezing and nasal drip were present in more than 35% of the subjects and nasal congestion in 25%. When the patients were separated in two groups, whether or not using a humidifier, no difference was found for any of the side effects described. The clinical presentation as to the clinical benefits obtained from N-CPAP were different when comparing mild vs moderate-to-severe SAS. However, no differences were shown in the two subgroups regarding the side effects due to the nasal mask. The discomfort of the N-CPAP apparatus in terms of noise was described more frequently in the subgroup with mild SAS. We did not observe any correlation between the side effects and the level of pressure used during N-CPAP. The rate of compliance remains high with a daily use of 6.5±3 h, with 88% of the patients using their device every night. This could be explained by the clinical benefit obtained: only 1% of the patients had no subjective benefit induced by their therapy. Snoring and daytime sleepiness were relieved in more than 65% of the subjects and sleep quality improved in 75%. In the present study, we have confirmed in two different centers in France that side effects were frequent during N-CPAP treatment. From this study, it also appears that the incidence of nasal side effects can be reduced with appropriate follow-up.

Section snippets

Patients

All patients treated with N-CPAP in the L and G sleep laboratories between January 1983 and November 1991 were studied.

The patients were all referred to the sleep laboratories with suspicion of SAS. All patients underwent full polysomnography using standard methods¹⁹ and all had a respiratory disturbance index (RDI) (apneas+hypopneas/hour slept) of more than 10/h.

The pressure setting of the machine was adjusted to the level required of pressure sufficient to abolish apneas and restore a correct

Patients

Patient characteristics are shown in Table 1. Sleep apnea syndrome usually was moderately severe and patients were mainly obese men about 60 years of age. There were more women in the L population than in that of G. There were no differences in initial presenting symptoms or cardiovascular morbidity pretreatment between the two centers (Fig 1).

Only 5% of patients had been previously treated by uvulopalatopharyngoplasty before starting N-CPAP.

Technical Aspects

Patients in L, on average had been receiving

DISCUSSION

In this study, we have shown a high incidence of side effects from N-CPAP in two centers in France. The patients from the two centers were comparable in severity of disease, clinical presentation, and the amount of pressure administered. Thus, we were able to analyze the effects of the severity of the disease, the type of device, and the type of nasal mask on the acceptance of N-CPAP, and the incidence of side effects.

Adverse effects of N-CPAP were mainly related to intolerance to the nasal

CONCLUSION

We conclude that the side effects of N-CPAP are mainly local to the nose, but that the treatment, nevertheless, remains acceptable to most patients because of the derived benefits. The incidence of nasal side effects may be reduced by use of individually fitted masks. Further study of the benefits of patient education and innovations such as a ventilatory support system (BiPAP) and autoadjusted N-CPAP are required.

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Chest

Clinical Investigations: Sleep and BreathingSide Effects of Nasal Continuous Positive Airway Pressure in Sleep Apnea Syndrome: Study of 193 Patients in Two French Sleep Centers

Section snippets

Patients

Patients

Technical Aspects

DISCUSSION

CONCLUSION

Clinical overview of the sleep apnea syndrome

Association of sleep apnea with myocardial infarction in men

Lancet

Snoring as a risk factor for ischaemic heart disease and stroke in men

BMJ

Snoring, sleep apnea syndrome, and stroke

Neurology

Nocturnal hypoxemia as a determinant of vigilance impairment in sleep apnea syndrome

Chest

Automobile accidents involving patients with obstructive sleep apnea

Am Rev Respir Dis

Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients

Chest

Long term outcome for obstructive sleep apnea syndrome patients: mortality

Chest

Physiologic basis of therapy for sleep apnea

Am Rev Respir Dis

Assessment of uvulopalatopharyngoplasty for the treatment of the sleep apnea syndrome

Sleep

Maxillofacial surgery and nasal CPAP: a comparison of treatment for obstructive sleep apnea syndrome

Chest

Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nose

Lancet

Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure

West J Med

Long-term compliance with nasal continuous positive airway pressure therapy of obstructive sleep apnea

Chest

Clinical Investigations: Sleep and Breathing
Side Effects of Nasal Continuous Positive Airway Pressure in Sleep Apnea Syndrome: Study of 193 Patients in Two French Sleep Centers