Air leak is common in patients using positive pressure airway therapy. Intentional leak is deliberately allowed to eliminate carbon di oxide. Unintentional leak generally occurs at the mask interface and causes a wide spectrum of complications and leads to poor CPAP adherence. This article reviews the interpretation of the leak profile. Many positive pressure systems have different algorithms to respond and quantitatively record the air leak. Once the high air leak is confirmed then variety of interventions are discussed to resolve the air leak and improve its efficacy. Two case examples are provided to fully understand the complex interplay amongst airflow; positive pressure ventilation to open the airway, volume of air leak and its impact on arousals and sleep is discussed.
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