SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee K. Brown and Adrian J. WilliamsOronasal mask may compromise the efficacy of continuous positive airway pressure on OSA treatment is there evidence for avoiding the oronasal route?Andrade, Rafaela Garcia Santos; Madeiro, Fernanda; Genta, Pedro Rodrigues; Lorenzi-Filho, GeraldoAuthor Information Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil Correspondence to Geraldo Lorenzi-Filho, Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo, Av. Enéas Carvalho de Aguiar 44, São Paulo, Brazil. E-mail: [email protected] Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-pulmonarymedicine.com). Current Opinion in Pulmonary Medicine: November 2016 - Volume 22 - Issue 6 - p 555-562 doi: 10.1097/MCP.0000000000000318 Buy SDC Metrics Abstract Purpose of review Continuous positive airway pressure (CPAP) delivered by nasal mask is the gold standard treatment for obstructive sleep apnea (OSA). However, oral and oronasal masks are also available. We considered experimental evidence and reviewed clinical trials that evaluated the impact of oral and oronasal mask on OSA treatment. Recent findings One recent study in 18 OSA patients that slept with a customized oronasal mask with two sealed compartments showed that the change of CPAP flow from nasal to oronasal and oral caused upper airway obstruction because of posterior displacement of the tongue demonstrated by nasoendoscopy. Oral masks use a mouthpiece that may stabilize the jaw and the tongue and have shown to be effective. However, oral masks are not widely used in clinical practice. Four out of five observational studies and all five reviewed randomized studies showed a worse performance of oronasal when compared with nasal masks. Oronasal masks were associated with higher residual apnea–hypopnea index, lower adherence, more leaks, and less satisfaction than nasal mask in the majority of the studies. Summary Nasal CPAP must be the first choice to treat OSA. Patients on oronasal mask should be carefully followed. http://links.lww.com/COPM/A17 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.