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Etude des déterminants des fuites non-intentionnelles au cours du traitement des troubles respiratoires du sommeil par pression positive et développement de stratégies innovantes pour le choix des masques et la gestion des fuites

Abstract : Continuous Positive Airway Pressure (CPAP) is the first-line treatment for moderate to severe Obstructive Sleep Apnea (OSA) syndrome. Unintentional leakage and its annoying consequences are the most frequently reported adverse effects. However, the causes of unintentional leaks are poorly understood. This thesis aimed at identifying the determining factors of unintentional leaks during CPAP treatment in OSA and developping innovative strategies for the selection of masks and leaks management.In our systematic review we have arbitrarily split the potential determining factors of leaks into two categories: 1) the non evolving factors overnight: nasal obstruction, age, high body mass index, central fat distribution and male sex were potential contributing factors associated with unintentional leakage. The oronasal mask was associated with higher unintentional leaks than the nasal mask; and 2) the evolving factors overnight such as sleep stages, body position, mouth opening and CPAP level. We studied these evolving factors in 74 OSA patients treated with auto-adjusting CPAP: mouth opening, CPAP level, body position and REM sleep were independently associated with an increased risk of unintentional leakage. We also highlighted that oronasal masks reduced the risk of unintentional leaks in cases of mouth opening and REM sleep. Since the CPAP level is a determining factor of leakage we evaluated through an ancillary analysis of a randomised controlled trial whether the type of CPAP (fixed versus auto-adjusting) could contribute to leakage. In this study, there was no effect of type of CPAP on leaks or the type of interface used after 4 month of treatment. Finally, in 214 patients, we prospectively evaluated the relevance of the Nasal Obstruction Syndrom Evaluation (NOSE) score as a simple decision-making tool to guide the choice of mask during CPAP initiation. A NOSE score > 50/100 at the initiation was independently associated with the use of an oronasal mask at 4 month. This score could be a simple tool for the objective assessment of nasal obstruction related to symptoms, facilitating the choice of an appropriate interface. As a conclusion, during this thesis we have developed a novel methodology to characterise and analyse the overnight determinants of unintentional leakage. Its clinical application could lead to individualised corrective measures of leaks. Further studies are needed to prospectively validate this model, as well as the clinical relevance of the NOSE score to guide the choice of mask in daily practice.
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Marius Lebret. Etude des déterminants des fuites non-intentionnelles au cours du traitement des troubles respiratoires du sommeil par pression positive et développement de stratégies innovantes pour le choix des masques et la gestion des fuites. Médecine humaine et pathologie. Université Grenoble Alpes, 2019. Français. ⟨NNT : 2019GREAS025⟩. ⟨tel-02503617⟩

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