Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance
Am. J. Respir. Crit. Care Med., Vol 154, No. 1, Jul 1996, 182-186.
GN Richards, PA Cistulli, RG Ungar, M Berthon-Jones and CE Sullivan
The last 2 authors are among the inventors of cpap.
Effect of mouth leak on effectiveness of nasal bilevel ventilatoryassistance and sleep architecture
Eur Respir J 1999; 14: 1251±1257
H. Teschler*, J. Stampa*, R. Ragette*, N. Konietzko*, M. Berthon-Jones**
ABSTRACT: Mouth leak is common during nasal ventilatory assistance, but its
effects on ventilatory support and on sleep architecture are unknown. The acute effect
of sealing the mouth on sleep architecture and transcutaneous carbon dioxide tension
(Ptc,CO2) was tested in 9 patients (7 hypercapnic) on longterm nasal bilevel ventilation
with symptomatic mouth leak.
Patients slept with nasal bilevel ventilation at their usual settings on two nights in
random order. On one night, the mouth was taped closed. Leak was measured with a
pneumotachograph.
Median leak fell from 0.350.07 (meanSEM) L.s-1 untaped to 0.060.03 L.s-1 taped.
Ptc,CO2 fell in 8/9, including all hypercapnic patients. Across all patients, the mean
Ptc,CO2 fell by 1.020.28 kPa (7.72.1 mmHg) with taping (p=0.007). Arousal index fell
in every patient. Mean arousal index fell from 35.03.0 to 13.91.2.h-1 (p<0.0001), and
rapid eye movement (REM) sleep increased from 12.91.5% to 21.11.8% sleep time
(p=0.0016). Slow wave sleep changed inconsistently, from a mean of 13.11.6% to
19.52.2% of sleep (p=0.09). Sleep latency and efficiency were unchanged. In four
healthy volunteers ventilator-induced awake hypopharyngeal pressure swing during
timed bilevel ventilation fell by 355%.L-1.s-1 of voluntary mouth leak (p<0.0001).
Mouth leak reduces effective nasal bilevel ventilatory support, increases transcutaneous
carbon dioxide tension, and disrupts sleep architecture.
My emphasis....
After I got over my shock at the idea of taping (took me some months to dare) , I taped happily for 4 years or more - had to switch to a full face mask because my beloved Headrest (a nasal pillows mask) was causing congestion that made me need to mouthbreathe.
And now here is my secret, a very simple secret; it is only with the heart that one can see rightly, what is essential is invisible to the eye.
Antoine de Saint-Exupery
Good advice is compromised by missing data
Forum member Dog Slobber Nov. 2023