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

Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, Research Institute MOVE, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
Respiration (Impact Factor: 2.59). 03/2011; 82(2):162-8. DOI: 10.1159/000324580
Source: PubMed


Long-term trials are needed to capture information regarding the persistence of efficacy and loss to follow-up of both mandibular advancement device (MAD) therapy and continuous positive airway pressure (CPAP) therapy.
The aim of the study was to compare these treatment aspects between MAD and nasal CPAP (nCPAP) in a 1-year follow-up.
Forty-three mild/moderate obstructive sleep apnea patients (52.2 ± 9.6 years) with a mean apnea-hypopnea index (AHI) of 20.8 ± 9.9 events/h were randomly assigned to two parallel groups: MAD (n = 21) and nCPAP (n = 22). Four polysomnographic recordings were obtained: one before treatment, one for the short-term evaluation, and two recordings 6 and 12 months after the short-term evaluation. Excessive daytime sleepiness (EDS) was also evaluated at the polysomnographic recordings.
The initially achieved improvements in the AHI remained stable over time within both groups (p = 0.650). In the nCPAP group, the AHI improved 4.1 events/h more than in the MAD group (p = 0.000). The EDS values showed a gradual improvement over time (p = 0.000), and these improvements were similar for both groups (p = 0.367). In the nCPAP group, more patients withdrew from treatment due to side effects than in the MAD group.
The absence of significant long-term differences in EDS improvements between the MAD and the nCPAP groups with mild/moderate obstructive sleep apnea may indicate that the larger improvements in AHI values in the nCPAP group are not clinically relevant. Moreover, nCPAP patients may show more problems in accepting their treatment modality than MAD patients.

14 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obstructive sleep apnea (OSA) is a common condition that can significantly affect daytime functioning, leading to excessive daytime sleepiness and fatigue. Motor vehicle crashes are common, resulting in financial burden, property loss, injury, and death. Motor vehicle operators are at increased risk for crash in the context of excessive daytime sleepiness and fatigue, largely due to inattention. The physician caring for individuals with risk of or diagnosed OSA must be aware of the potentially increased risk for motor vehicle crashes, especially in professional drivers. Because of empiric data on increased risk for crashes in commercial vehicle operators, the importance of identifying OSA has become the subject of focused attention by the Federal Motor Carrier Safety Administration (FMCSA). A task force has published recommendations for clinical care and urged further research on the interplay between sleep apnea, sleepiness, and crash risk. Despite the logical relationship between OSA and motor vehicle crashes, data to support this theory remain of overall modest quality. Recent case-control and cohort studies continue to produce supportive evidence. Additionally, several meta-analyses of past studies have supported the crash risk associated with OSA and confirmed improvement with effective treatment using continuous positive airway pressure. Further study is needed to more fully characterize the interplay between sleepiness and OSA, the crash risk associated with untreated OSA, and the benefit of treatment on reducing crash risk. For now, empiric recommendations are offered to screen and manage all individuals who drive, particularly those who drive professionally.
    Current opinion in pulmonary medicine 09/2011; 17(6):412-8. DOI:10.1097/MCP.0b013e32834b96a4 · 2.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    European Respiratory Journal 11/2011; 39(5):1241-7. DOI:10.1183/09031936.00144711 · 7.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Oral appliances (OAs) are a primary treatment option for snoring and mild to moderate obstructive sleep apnea (OSA) and are implemented as a noninvasive alternative for patients with severe OSA who are unwilling or unable to tolerate continuous positive airway pressure for the management of their disease. Studies have demonstrated the ability of OAs to eliminate or significantly reduce the symptoms of OSA and produce a measurable influence on the long-term health effects of the disease. Most studies have evaluated one type of OAs, the mandibular advancement splints. This article describes the effectiveness and outcomes of mandibular advancement splints.
    Dental clinics of North America 04/2012; 56(2):433-44. DOI:10.1016/j.cden.2012.02.003
Show more