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: 2.92). 03/2011; 82(2):162-8. DOI: 10.1159/000324580
Source: PubMed

ABSTRACT 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.

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    The Scientific World Journal 01/2015; 2015. · 1.22 Impact Factor
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    ABSTRACT: Background: Dental practitioners have a key role in the quality of life and prevention of occupational accidents of workers with Obstructive Sleep Apnea Syndrome (OSAS). Aim: The aim of this study was to review the impact of OSAS, the Continuous Positive Airway Pressure (CPAP) therapy, and the evidence regarding the use of oral appliances (OA) on the health and safety of workers. Materials and Methods: Searches were conducted in MEDLINE (PubMed), Lilacs and Sci ELO. Articles published from January 1980 to June 2014 were included. Results: The research retrieved 2188 articles and 99 met the inclusion criteria. An increase in occupational accidents due to reduced vigilance and attention in snorers and patients with OSAS was observed. Such involvements were related to excessive daytime sleepiness and neurocognitive function impairments. The use of OA are less effective when compared with CPAP, but the results related to excessive sleepiness and cognitive performance showed improvements similar to CPAP. Treatments with OA showed greater patient compliance than the CPAP therapy. Conclusion: OSAS is a prevalent disorder among workers, leads to increased risk of occupational accidents, and has a significant impact on the economy. The CPAP therapy reduces the risk of occupational accidents. The OA can improve the work performance; but there is no scientific evidence associating its use with occupational accidents reduction. Future research should focus on determining the cost-effectiveness of OA as well as its influence and efficacy in preventing occupational accidents.
    Indian journal of occupational and environmental medicine 12/2014; 18(2):39-47.
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    ABSTRACT: Introduction: For the management of obstructive sleep apnea (OSA) in adults, some professionals prescribe continuous positive airway pressure (CPAP) while others prefer mandibular advancement devices (MADs). However, both CPAP and MADs represent life-long therapy. In this study, we investigated the use of a biomimetic oral appliance system (the DNA appliance® system) to test the hypothesis that the upper airway can be improved in adults that have been diagnosed with OSA. Methods and Sample: We recruited 10 consecutive adults for this study who underwent an overnight sleep study, which was interpreted by a sleep physician. Subjects diagnosed with mild to moderate OSA were treated using biomimetic oral appliance therapy (BOAT). Each subject had monthly follow-up visits, including examinations for progress and adjustments of the devices. The mean AHI of the sample was calculated prior to and after BOAT with no appliance in the mouth. The findings were subjected to statistical analysis. Results: The mean treatment time was 8.7 mos. ± 5.8. Prior to treatment the mean AHI was 13.2 ± 7.2. The mean AHI fell by 65.9% to 4.5 ± 3.6 (p = 0.021) after BOAT with nothing in the mouth when the final overnight sleep study was performed. Conclusions: This preliminary study suggests that BOAT may be able to reduce the AHI to within normal limits perhaps to the extent that life-long therapy may not potentially be necessary. However, long-term follow up is needed to determine whether these subjects need a maintenance program to retain their initial upper airway improvements.
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