Air Leakage and Adherence to Continuous Positive Airway Pressure Therapy in Patients with Moderate to Severe Obstruction Sleep Apnoea: A Cross Sectional Study

Sains Malaysiana 51(5)(2022): 1505-1510 http://doi.org/10.17576/jsm-2022-5105-19

ABSTRACT This multicentre study aimed to evaluate the air leakage following a palatal surgery and its effect on CPAP adherence in OSA patients. The data on air leakage and adherence were objectively obtained and evaluated from the recorded CPAP therapy data. Forty patients were divided into two groups: surgery (18 patients) and non-surgery (22 patients). The mean air leakage level was 7.62±8.14% and 12.62±13.81% and mean adherence was 51.44±35.27% and 60.03±27.04% for surgery and non-surgery, respectively. There was no significant difference in CPAP adherence (p=0.389) but for mean air leakage it was significantly higher in non-surgery (p<0.01). The occurrence of significant air leakage during CPAP therapy was not associated with surgery (p=0.436). There was no association between poor CPAP adherence and surgery (p=0.622). In terms of impact of palatal surgery, it did not cause significant leakage with no significant association to poor adherence.

INTRODUCTION Obstructive sleep apnoea (OSA) is a type of sleep disorder characterised by recurrent partial or complete pharyngeal obstruction during sleep (Strollo & Rogers 1997). This results in neurocognitive, cardiovascular, and metabolic disorders (Aurora & Punjabi 2013; Rosenzweig et al. 2015; Sánchez-de-la-Torre et al. 2013). Therefore, it is crucial to treat OSA patients. CPAP therapy has been the gold standard treatment (Sullivan et al. 1981). However, adherence to CPAP therapy remains an issue due to problems related to mask fit, such as eye irritation, silicone allergies, pressure sores and air leaks (Neuzeret & Morin 2017). Air leakage is experienced by up to 50% of nasal CPAP users (Pépin et al. 1995). Air leakage can be divided into intentional and unintentional leaks. Intentional leaks are important to allow the exhalation of carbon dioxide. Unintentional air leaks can be caused by leakage from weak mask seal, holes along the tubing and palatal surgery for OSA. Surgical modality is a treatment option for patients who fail CPAP therapy. Common surgery performed at palatal level include uvulopalatopharyngoplasty (UPPP), cautery assisted palatal stiffening operation (CAPSO), anterior palatoplasty, and their modification. Their aim is to induce fibrosis at soft palate to prevent collapse of the velopharynx during sleep. However, it is common that these patients would still need CPAP when the surgery failed to alleviate the symptoms and cure the OSA. Some studies showed that palatal fibrosis following the surgery may compromise CPAP therapy by increased mouth air leak, leading to poor compliance (Mortimore et al. 1996; Richards et al. 1996), but other studies documented otherwise with improved outcomes (Chandrashekariah et al. 2008; Friedman et al. 2009). Thus, the results in the literature have been contradicting. The present study was performed to compare air leakage between surgery group (those who has underwent anterior palatoplasty with lateral wall release) and non-surgery group and to investigate the association of significant air leakage with the surgery. The study also investigated the effect of the surgery on adherence to CPAP therapy among OSA patients. The hypothesis of this study is anterior palatoplasty would not cause significant air leakage and do not affect the adherence to CPAP therapy.

Sains Malaysiana 51(5)(2022): 1505-1510 http://doi.org/10.17576/jsm-2022-5105-19