False High Respiratory Distress Index Due to Mask Leak During Continuous Positive Airway Pressure Titration

The treatment of choice for moderate-to-severe obstructive sleep apnea (OSA) is continuous positive airway pressure therapy (CPAP), and the optimal pressure for the elimination of obstructive events is set on the basis of titration study. Treatment-emergent central sleep apnea (TECSA) is characterized by new onset of central apneas in a patient with OSA, while on CPAP therapy. Many risk factors, including some polysomnographic parameters, have an association with TECSA. One such easily correctable factor is mask leak. Mask fitting during CPAP titration is a very important consideration and loose masks can lead to air leaks, causing redness of the eyes, and in some cases, arousal and even central sleep apneas.