SideEffects ofNasalContinuous Positive AirwayPressure inSleepApnea Syndrome*of193Patients inTwoFrenchSleepCenters

Nasal continuous positive airway pressure (N-CPAP) is nowthetreatment ofchoice forpatients withsleep apneasyndrome (SAS). Sideeffects andadverse reactions havebeendescribed withthis device. Wehavetherefore systematically studied sideeffects ofN-CPAPin193 patients recruited consecutively fromtwoFrench sleep centers (Lyon andGrenoble). Patients werefollowed up withrepeated polysomnography, clinical assessment, andaformal questionnaire aboutsubjective benefits andside effects oftreatment. Thepatients (meanage, 59±12years) wereobese (body massindex, 32+7kg/ mi2) andhadbeenusing N-CPAPfor19±17months for moderate tosevere SAS(respiratory disturbance index [RDI]=53 ±25/h). Theclinical presentation wasthe sameinthetwosleep centers. Fifty percent ofthepatients complained ofatleast oneside effect duetothe nasal mask(allergy totheface, airleaks, abrasions ofthe ridge ofthenose). Using individually molded masks, the patients exhibited fewer abrasions ofthebridge ofthe nose(p<0.01) andhadredeyesevery morning inonly 9%ofcases vs24%forthepatients using industrial silicone nasal masks(p<0.025). Patients withsilicone nasalmasksalso hadmoreallergic reaction totheface (13%vs5%),butthis difference didnotreach significance. Drynoseormouthinthemorning affected 65% ofthepatients. Sneezing andnasal drip werepresent in morethan35%70 ofthesubjects andnasal congestion in 25%.Whenthepatients wereseparated intwogroups, whether ornotusing ahumidifier, nodifference was Sleepapnea syndrome (SAS) isdefined bytheoccurrence ofmorethanfive apneas perhourof sleep.' Cardiovascular2-4