While the key component of positive airway pressure (PAP) therapy for OSA is certainly the flow generator, interfaces are equally important to delivering pressures effectively—and comfortably.

Poor PAP compliance may be traced to patients complaining that an interface was somehow uncomfortable—too tight, too loose, with leaks that burn the eyes and decrease the pressure. Interface manufacturers are addressing those concerns by improving comfort. These days, improved face contouring, improved silicone and gel pads, as well as making interfaces easy to adjust are common trends.

PAP industry watchers, such as Johnny Goodman, general manager of CPAP.com, a Missouri City, Tex-based CPAP and accessory provider, says that interface designs of today are fairly mature and that further improvements will be incremental.

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“The basic designs of nasal pillow, nasal, and full-face masks were developed long ago and have been refined,” observes Goodman. “So, the designs are maturing. If we are going to have significant improvements, new and creative ways to deliver airway pressure will power them.”

Patient Preference Trends

CPAP.com publishes regular updates on user preferences based on its Internet sales figures and patient ratings (www.cpap.com/cpap-user-preference.php). Goodman reports that over the last 3 years, nasal masks have lost market share, going from 73.7% to 56.1%, while nasal pillow and prong devices have surged from 14.2% to 26.3% during that same period. At the same time, full-face masks have grown from 12.1% to 17.7% market share.

Dave Jackson, executive director of Awake in America, Philadelphia, a national nonprofit organization focused on sleep-related issues and sleep disorders, receives many calls, e-mails, and instant messages from patients about different interfaces.

Jackson says that based on his various patient contacts through October 2008, patients appear to be using more nasal masks than in previous years, though he says that the nasal pillow type remains the second most popular type of mask.

While Jackson’s anecdotal trend does not match CPAP.com’s figures, both agree that full-face masks—while not as popular as the other two interface types—appear to have a growing following, even among individuals who do not have a traditional need for full face masks.

Jackson says, “Many of the people who call Awake in America for help with a variety of issues about the masks often tell us that the full-face masks are their preference because they are light and balanced, and allow them to sleep in any position.”

For CPAP.com Internet buyers, as of October 2008, the five most highly rated nasal CPAP masks are the following:

  • ComfortGel, Respironics, 4.4 of 5 rated by 1,427 buyers
  • Profile Lite, Respironics, 4.6 of 5 rated by 655 buyers
  • ComfortClassic, Respironics, 4.4 of 5 rated by 697 buyers
  • Ultra Mirage II, ResMed, 4.6 of 5 rated by 296 buyers
  • Mirage Activa, ResMed, 4.6 of 5 rated by 325 buyers

Regardless of the type of interface or innovation, Jackson strongly believes that patient education about masks is most important for effective therapy.

Tor Valenza is a staff writer for Sleep Review. He can be reached at [email protected].