Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non‐adherent to CPAP

Abstract

SummaryThe aim of this retrospective study was to evaluate the effect of individually adjusted custom‐made mandibular advancement device/oral appliance (OA) in treatment of patients with moderate and severe obstructive sleep apnoea (OSA), who were non‐adherent to continuous positive airway pressure (CPAP) therapy. During 2007‐2013, 116 patients with moderate (n = 82) and severe (n = 34) OSA non‐adherent to CPAP treatment were referred for dental management with an individually adjusted OA at a specialist sleep clinic. Ten of the participants (8·6%) were lost to follow‐up, leaving the data set to consist of 106 patients (71 men/35 women, mean age 57 year, range 28‐90). Nocturnal respiratory polygraphic recordings were performed at baseline and follow‐up. Average time between baseline polygraphy and follow‐up was 12 months. A successful OA treatment outcome was based on polygraphy at the follow‐up and divided into three groups: 1 = AHI <5; 2 = 5 ≤ AHI <10 and >50% reduction in baseline AHI; and 3. >50% reduction in baseline AHI. If there was a ≤ 50% reduction in baseline AHI at the follow‐up, the treatment was considered as a failure. The overall treatment success rate was 75%. There was no significant difference in success rates between patients in the moderate and severe categories (69% and 77%, respectively). Low oxygen saturation (SpO2 nadir) had a high predictive value for OA treatment failure. OA treatment of patients non‐adherent to CPAP is efficient and especially promising for the severe OSA group who are at greatest risks for developing serious comorbidities, if left untreated.

Therapeutic outcomes of mandibular advancement devices as an initial treatment modality for obstructive sleep apnea

“…[7,8] Mandibular advancement devices (MADs) are the most common class of oral appliances used to treat snoring or OSA and are considered simple, safe, and cost-effective options. [9,10] All devices protrude the mandible and induce changes in the anterior position of the tongue, soft palate, and lateral pharyngeal wall, resulting in improved airway patency. [11,12] Recent evidence has suggested that MADs also improve sleep-disordered breathing and are also typically used for OSA patients who demonstrate retroglossal area narrowing with mild OSA symptoms.…”

“…In particular, MADs may be suggested to patients who have difficulty in tolerating CPAP treatment or are unable to undergo sleep surgery as an alternative treatment modality. [9] MADs are classified according to adjustability when they contain a mechanism to increase the degree of mandibular advancement, or fixed when they are manufactured in a fixed position. They can be designed to monobloc or duobloc, depending on whether the MAD is composed of 1 or 2 pieces.…”

Bias in Dental Sleep Medicine Research: Does it Matter to Clinicians?

“…The duration from appliance prescription to followup polysomnography in the STOP group was longer than that in the control group (147 [115-215] vs 113 [70-198] days, P < .05, Mann-Whitney U test). The apnea-hypopnea index (AHI) was improved in both the STOP group (16 [10][11][12][13][14][15][16][17][18][19][20][21][22] to 3 [2][3][4][5][6][7] events/h, P < .05) and the control group (18 [13][14][15][16][17][18][19][20][21][22][23][24][25][26] to 6 [3][4][5][6][7][8][9][10][11] events/h, P < .05). However, a greater percentage of subjects achieved a follow-up AHI of < 5 events/h with a > 50% reduction in baseline AHI in the STOP group (44 of 69 patients, 64%) than in the control group (94 of 228 subjects, 41%) (P < .05, chi square test).…”

Sleep Apnea – Recent Updates

“…Studies have demonstrated eicacy of oral appliance therapy comparable to CPAP in selected patients [56,57]. While oral appliances help to decrease AHI/RDI/REI across all severity levels, there are few reported factors that consistently predict improvement in OSA using oral appliances.…”

“…Among these are changes in pharyngeal geometry under drug-induced sleep endoscopy (DISE) [58] and nasoendoscopy to assess velopharynx/oro/hypopharyngeal geometry [59]. In the study of Gjerde [57], low oxygen levels carried a high predictive value for failure with oral appliance therapy.…”