面罩选择对成人阻塞性睡眠呼吸暂停患者持续气道正压治疗依从性的影响

文献信息

中文摘要

背景： 面罩选择是成人阻塞性睡眠呼吸暂停（OSA）患者持续气道正压（PAP）疗效的少数可改变决定因素之一，然而选择往往受惯例、习惯或当地库存而非证据的影响。我们回顾了近期文献，重点介绍过去18个月的研究，并纳入应影响处方选择的基础机制和结局研究。

结果： 大规模远程监测分析证实，鼻面罩在依从性、所需压力、残余呼吸暂停低通气指数（AHI）和非故意漏气方面优于口鼻面罩。将患者从口鼻面罩转换为鼻面罩可使依从性提高多达77%。PAP下药物诱导睡眠内窥镜检查、电影MRI和密封腔生理学研究提示这些观察结果的三种主要机制：无口腔气流时的口腔压力传导、舌后部和下颌移位，以及咽部塌陷性增加。下颌运动信号可进行漏气表型分析，区分面罩密封失败与张口，支持针对性干预而非反射性更换接口。

结论： 当前证据支持鼻面罩优先的处方策略，并使用远程监测的依从性、残余AHI和漏气波形数据进行结构化早期随访。口鼻面罩应保留用于有记录且结构化鼻面罩试验失败的情况，而非基于自我报告的呼吸路径进行选择。

英文摘要

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.