Work

Respiratory Effort–Driven Mandibular Opening as a Mechanism of Air Leak During CPAP Therapy

Year: 2026

Type: article

Abstract: RATIONALE: Unintentional air leaks are common during continuous positive airway pressure (CPAP) therapy and represent a leading cause of treatment failure. OBJECTIVE: To investigate the temporal association between respiratory effort (RE)-driven mouth opening and the occurrence of mouth leaks in patients with obstructive sleep apnea (OSA) during CPAP therapy. METHODS: Polysomnography with simultaneous mandibular jaw movements (MJM) and leak-flow monitoring was conducted in 200 OSA patients during CPAP therapy. The main analysis included 1,494 data fragments (mean duration: 9.34 ± 6.33 min) classified as leak-free controls, sequential intermittent leaks (Group A), and isolated sustained leaks (Group B). Multistep analyses included regression modeling and bidirectional Granger-causality testing. MEASUREMENTS AND MAIN RESULTS: Compared with leak-free control fragments, leak periods were significantly associated with higher levels of RE and mouth opening amplitudes. Regression analyses showed that mouth leaks were associated with increased sleep fragmentation, significant reduction in N3 sleep stage proportion (-5.34%) and more residual obstructive events during CPAP. Each 1-standard deviation increase in the number of leak episodes was associated with a 38% increase in arousal index and a 34% increase in residual obstructive apnea/hypopnea event rate. Bidirectional Granger-causality tests indicated that mouth opening was preceded by increased RE and subsequently induced leaks in most cases (Group A, 93.6%; Group B, 91.5%). CONCLUSION: Mouth opening driven by persistent RE is a measurable mechanism contributing to the overall burden of mouth leaks during CPAP therapy in OSA. Integrating MJM recordings with leak monitoring may help identify leak origin, guide targeted interventions, and ultimately improve CPAP effectiveness and adherence.

Source: Annals of the American Thoracic Society

DOI: 10.1093/annalsats/aaoag253

Authors: Jean-Benoît Martinot, Nhat-Nam Le-Dong, Didier Clause, Atul Malhotra, Jean-Louis Pépin

Institutions: CHU Dinant Godinne UCL Namur, University of California San Diego, Inserm, Université Grenoble Alpes

Language: English

Topic: Obstructive Sleep Apnea Research

Subfield: Physiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute