Long-Term Follow-Up of a Randomized Controlled Trial of Oral Appliance Therapy in Obstructive Sleep Apnea

Lobbezoo, Frank; Heymans, Martijn W.; Hamburger, Hans; Naeije, M.

doi:10.1159/000324580

Cited by 115 publications

(126 citation statements)

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“…In 93 potentially relevant references, 17 papers were taken for a comprehensive evaluation. After retrieving the full articles, one was excluded because of duplicated data 18 and 2 were excluded because of nonclinical outcomes. 19,20 Finally, 14 studies were included in this metaanalysis.…”

Section: Withdrawals and Dropoutsmentioning

confidence: 99%

The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

Xiao

2013

Respir Care

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BACKGROUND: A systematic review and meta-analysis was performed to compare the outcomes of oral appliances (OAs) with those of CPAP in treatment of patients with obstructive sleep apnea (OSA). METHODS: Relevant studies were retrieved from the following electronic databases, up to and including September 2012: MEDLINE, PubMed, EMBASE, and Central Register of Controlled Trials. The main outcomes were Epworth Sleepiness Scale score, health-related quality of life, cognitive performance, blood pressure, apnea-hypopnea index (AHI), arousal index, minimum S pO 2 , percent rapid eye movement sleep, treatment usage, side effects, treatment preference, and withdrawals. RESULTS: Fourteen trials were finally included in this review. Our results demonstrated that the effects on Epworth Sleepiness Scale score (P ‫؍‬ .31 and .09 in crossover and parallel-group trials), health-related quality of life, cognitive performance, and blood pressure of OAs and CPAP were similar. Besides, pooled estimates of crossover trials suggested a significant difference in favor of CPAP regarding AHI (P < .001), arousal index (P ‫؍‬ .001), and minimum S pO 2 (P < .001), while pooled estimates of parallel-group trials showed a significant difference in favor of CPAP regarding AHI (P < .001) and percent rapid eye movement sleep (P ‫؍‬ .02). Moreover, OAs and CPAP yielded fairly similar results in terms of treatment usage (P ‫؍‬ .26 for hours/night in crossover trials, and P ‫؍‬ .14 for hours/night and P ‫؍‬ .19 for nights/week in parallel-group trials), treatment preference, side effects, and withdrawals (P ‫؍‬ .34 in parallel-group trials). CONCLUSIONS: CPAP yielded better polysomnography outcomes, especially in reducing AHI, than OAs, indicating that OAs were less effective than CPAP in improving sleep-disordered breathing. However, similar results from OAs and CPAP in terms of clinical and other related outcomes were found, suggesting that it would appear proper to offer OAs to patients who are unable or unwilling to persist with CPAP.

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Section: Withdrawals and Dropoutsmentioning

confidence: 99%

The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

Xiao

2013

Respir Care

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“…Three studies reported longer-term results from MAD treatment after 1-4 yrs, compared with CPAP [12], surgery [37] or between two types of MAD [21]. The majority (74%) of the RCTs used polysomnography (PSG), while the other researchers utilised limited sleep recordings or combinations of these methods to analyse sleep-disordered breathing.…”

Section: Description Of the Included Studiesmentioning

confidence: 99%

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Marklund¹,

Verbraecken²,

Randerath³

2011

Eur Respir J

171

136

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Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report.Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA.In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

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“…In randomized controlled trials comparing both modalities of treatment, CPAP therapy is consistently more effective in reducing sleep disordered breathing events. [6][7][8][9] While CPAP and MAS have similar subjective and cardiovascular outcomes, patients tolerate MAS better. [8][9][10][11] The superior patient satisfaction associated with the use of MAS reflects the relative simplicity and convenience of this form of treatment.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…[6][7][8][9]19 Randomized control trials have shown no significant differences in subjective sleepiness and quality of life when comparing CPAP to MAS. 8,20,21 Our study showed an interesting and important finding in terms of daytime sleepiness.…”

mentioning

confidence: 99%

Mandibular Advancement Splint as Short-Term Alternative Treatment in Patients with Obstructive Sleep Apnea Already Effectively Treated with Continuous Positive Airway Pressure

Almeida

Mulgrew

Ayas

et al. 2013

Journal of Clinical Sleep Medicine

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MAS are now widely used for the treatment of OSA both as a primary therapy and as an alternative for patients with severe OSA who are unwilling or unable to tolerate CPAP. 5 MAS are a simple, reversible, quiet, and cost effective therapy for selected patients with OSA. study objectives: CPAP is used as the fi rst-line treatment for patients with severe OSA, but this machine is not always feasible to use on the long term. We performed a clinical trial to determine whether patients with OSA could use a mandibular advancement splint (MAS) as a short-term treatment alternative to CPAP. Methods: Twenty-two patients adherent with CPAP therapy were recruited to the study. Each patient used the MAS for approximately 4 months. The transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP during the MAS titration until subjective improvement or maximum mandibular advancement was achieved. Sleepiness (ESS), quality of life (SAQLI), and polysomnography were recorded prior to and after MAS titration. Patients recorded CPAP or MAS usage for the following 3 months. Results: Seven women and 12 men with a mean age of 53.8 (± 12.1) years and mean body mass index of 28.1 (± 4.8) kg/m 2 completed the clinical trial. Prior to MAS, CPAP adherence was 5.8 h/night. AHI decreased signifi cantly with MAS use compared to baseline (30.7 ± 23.1 vs 13.2 ± 11; p < 0.01). Fourteen patients (74%) had > 50% decrease in their AHI, while 2 patients had an increase in their AHI. There were no signifi cant differences in SAQLI between MAS and CPAP treatment, while ESS decreased signifi cantly on MAS. MAS self-reported usage was correlated with treatment effi cacy (r = 0.52; p < 0.05). Seventy-fi ve percent of the patients reported being suffi ciently satisfi ed with MAS to continue to use it as an alternative short-term therapy. s C I e N t I F I C I N V e s t I g A t I o N sO bstructive sleep apnea (OSA) is a common syndrome that is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. OSA is associated with reduced quality of life, decreased cardiovascular health and increased healthcare utilization, car crashes, and mortality.1,2 There are a variety of treatment options currently available for OSA including lifestyle modifi cations, continuous positive airway pressure (CPAP), mandibular advancement splints (MAS), and corrective upper airway surgery. CPAP is the most effi cient treatment for OSA and has been demonstrated to improve daytime symptoms and reduce cardiovascular disease and car crashes. 3,4 Despite improvements in the portability of CPAP machines, many patients fi nd this treatment not feasible when away from home. CPAP machines require access to a reliable electrical source while asleep. This can sometimes be provided by a battery, but is quite cumbersome and needs periodic recharging. Many patients faced with short-term diffi culties complying with CPAP during periods of travel or vacation stop treatment in these circumstances. Current knowle...

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Long-Term Follow-Up of a Randomized Controlled Trial of Oral Appliance Therapy in Obstructive Sleep Apnea

Cited by 115 publications

References 58 publications

The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Mandibular Advancement Splint as Short-Term Alternative Treatment in Patients with Obstructive Sleep Apnea Already Effectively Treated with Continuous Positive Airway Pressure

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