CPAP for Severe Obstructive Sleep Apnea: Does Discomfort Warrant Discontinuation?

Continuous positive airway pressure (CPAP) therapy has just been prescribed for a 40-year-old woman who experiences severe obstructive sleep apnea (OSA) syndrome by her sleep physician. She returns to your office, following a week of CPAP use, and complains that she does not like using CPAP because the mask is uncomfortable.  

What is the most appropriate next step?

A. Discontinue CPAP
B. Refer the patient for consideration of upper airway surgery
C. Ask the patient to return to her sleep physician’s CPAP clinic
D. Consider management with an oral appliance
E. Order a switch to a smaller mask

Please click here for the answer and discussion.