The Importance of Appropriate PAP Silicone Mask Selection in Sleep Apnea Management

Abstract

Positive airway pressure (PAP) is the standard treatment for patients with moderate to severe obstructive sleep apnea, especially when a correctable anatomic obstacle is not identified. The PAP efficiency strongly depends on the appropriate use during sleep. Despite the recent advancements in PAP interface designs, overall adherence to therapy remains low. The main sources of discomfort consist of air leakage and mask overtightening leading to skin problems. However, these disadvantages have been partially reduced by new interfaces like nasal pillows that have the capacity to reduce the contact of the silicone cushion with the skin, reducing the chances of skin irritation. At the same time, assuring a better seal prevents air leakage and is particularly useful in patients with internal valve insufficiency. We present a case of a 57-year-old patient with severe sleep apnea syndrome whose efficient treatment was delayed by an inadequate PAP mask prescription at diagnosis. Due to low treatment compliance secondary to the perceived adverse effects of the oronasal mask, the patient decided to discontinue treatment for two years with subsequent aggravation of sleep apnea symptoms. The patient’s sensitivity to the silicone mask cushion and treatment ineffectiveness due to internal valve collapse were the main causes of treatment failure. After changing of PAP interface, the patient achieved long-term compliance. Our case report reflects the importance of choosing the most suitable PAP interface in accordance with the patient’s particularities. In the absence of this approach, appropriate treatment might be delayed with detrimental consequences, especially in severe cases. Considering PAP adherence following therapy initiation usually predicts long-term compliance, finding the best mask design from the beginning can predict therapeutic success.