Oral appliance therapy in obstructive sleep apnea: Long-term adherence and patients' (TM) experiences

Abstract

BackgroundDespite the advances in the treatment of obstructive sleep apnea (OSA) with mandibular advancement appliances (MAA), their effectiveness is dependent on the patients’ compliance. Our aims were to evaluate the long-term adherence to MAA therapy and patients’ experiences of the treatment in OSA.Material and MethodsSixty-nine patients (52 males, 17 females; Mean age: 54.4±10.8 years) were included in the study. The subjects were mild (56%) and moderate (44%) OSA patients who had been treated using MAA at least 4 years prior to the study. A phone survey was used to determine the demographic characteristics of the patients, as well as to assess self-reported adherence to therapy, subjective long-term effectiveness, and patient experiences with the appliance. Descriptive statistics, Pearson Chi-square test, and independent samples t-test were used for data analysis.ResultsOnly 22 (32%) patients reported using the appliance regularly. Most of the non-adherent patients had stopped using their appliances in the first year (55%). The mean duration of appliance use was 33.5 months (Median: 12 months). No significant differences in appliance type, OSA severity, educational level, gender, marital status, income status, employment status or place of residence existed between adherent and non-adherent subjects. Adherent subjects were significantly younger than non-adherent subjects (Age: 50.6 ± 11.9 versus 56.1 ± 9.9, p<0.05). The most common reasons reported by patients were inability to adapt to the appliance (62%) and pain in the temporomandibular joint (38%). The most common factors associated with continued usage were effectiveness (100%) and ease of use (64%).ConclusionsThe overall long-term nonadherence to MAA therapy in mild-to moderate OSA patients was high suggesting that barriers to MAA therapy adherence should be prevented to increase the efficiency of oral appliance treatment in OSA and achieve better outcomes for this disease. Key words:Obstructive sleep apnea, mandibular advancement, therapy, oral appliance, long-term compliance.

Obstructive Sleep Apnea in Adults

“…Perhaps even more challenging is to lose weight 35,36 and maintain an adequate BMI. Thus, it is not surprising that several patients discontinue treatment over the years, either the CPAP 37 or MAD 38 use or the maintenance of adequate BMI. Possibly, at the current stage of development of OSAS treatments, more important than finding the hypothetically optimal therapy for a patient, is to keep the patient in the treatment loop.…”

Strategies to augment adherence in the management of sleep‐disordered breathing

“…Compared with PAP, oral appliance (OA) adherence is usually higher but is also highly variable with 1‐year compliance estimates between 32% and 82%. Comparison of the two modalities is limited, however, as the majority of studies compare subjective reports of OA use with objective CPAP usage data …”

“…Comparison of the two modalities is limited, however, as the majority of studies compare subjective reports of OA use with objective CPAP usage data. [13][14][15][16] In the past, the accuracy of PAP adherence estimates has been limited by self-reporting, which was often unreliable. This situation has changed as device technology now allows for objective measurement of use.…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…Researchers in Turkey examined the long-term (LT) adherence to MAD treatment and patients' experiences related to the course of treatment. 294 Sixty-nine patients participated in the study (52 men and 17 women; mean age: 54.4 ±10.8 years). Mild (56%) and moderate (44%) OSA had been treated for at least 4 years previously with a MAD.…”