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Correction: Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD

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Authors:
Hsiang-Wen Liu
Hsiang-Wen Liu
Hsiang-Wen Liu
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Yunn-Jy Chen at National Taiwan University
Yunn-Jy Chen
Jennifer Lai at University of Michigan
Jennifer Lai
Ching-Yi Huang
Ching-Yi Huang
Ching-Yi Huang
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CORRECTION
Correction: Combining MAD and CPAP as an
effective strategy for treating patients with
severe sleep apnea intolerant to high-
pressure PAP and unresponsive to MAD
Hsiang-Wen Liu, Yunn-Jy Chen, Yi-Chun Lai, Ching-Yi Huang, Ya-Ling Huang, Ming-
Tzer Lin, Sung-Ying Han, Chi-Ling Chen, Chong-Jen Yu, Pei-Lin Lee
Fig 4 is incorrect. Please see the corrected Fig 4 here.
PLOS ONE | https://doi.org/10.1371/journal.pone.0196319 April 19, 2018 1 / 3
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OPEN ACCESS
Citation: Liu H-W, Chen Y-J, Lai Y-C, Huang C-Y,
Huang Y-L, Lin M-T, et al. (2018) Correction:
Combining MAD and CPAP as an effective strategy
for treating patients with severe sleep apnea
intolerant to high-pressure PAP and unresponsive
to MAD. PLoS ONE 13(4): e0196319. https://doi.
org/10.1371/journal.pone.0196319
Published: April 19, 2018
Copyright: ©2018 Liu et al. This is an open access
article distributed under the terms of the Creative
Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in
any medium, provided the original author and
source are credited.
PLOS ONE | https://doi.org/10.1371/journal.pone.0196319 April 19, 2018 2 / 3
Reference
1. Liu H-W, Chen Y-J, Lai Y-C, Huang C-Y, Huang Y-L, Lin M-T, et al. (2017) Combining MAD and CPAP
as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP
and unresponsive to MAD. PLoS ONE 12(10): e0187032. https://doi.org/10.1371/journal.pone.
0187032 PMID: 29073254
Fig 4. The (A) residual apnea-hypopnea index (AHI), (B) residual oxygen desaturation index (ODI), and (C) residual
percentage of total sleep time with SpO
2
<90% (%TST-SpO
2
<90%) before and under treatments with PAP, MAD,
and CT in 14 patients. PAP, continuous positive airway pressure; MAD, mandibular advancement device; CT,
combination therapy. Each dot represents a measurement of an individual patient. The pvalues were analyzed by
Tukey’s correction: # p<0.05 and ### p<0.005 compared with pretreatment values; p<0.05,  p<0.01, and
 p<0.005 compared with PAP therapy; § p<0.05 and §§§ p<0.005 compared with MAD therapy.
https://doi.org/10.1371/journal.pone.0196319.g001
PLOS ONE | https://doi.org/10.1371/journal.pone.0196319 April 19, 2018 3 / 3
Available via license: CC BY
Content may be subject to copyright.
... Long term side effects of MAD therapy are dental and skeletal changes, which are progressive over time [82]. It stands to reason that combination therapy of CPAP and MAD may also be considered as the CPAP might be more comfortable at lower therapeutic pressures resulting in improved sleep metrics [83]. ...
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Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD
Article
Full-text available
Introduction This study aimed to determine the effect of combining positive airway pressure (PAP) therapy and mandibular advancement device (MAD) in patients with severe obstructive sleep apnea (OSA) who were pressure intolerant for PAP and were unresponsive to MAD. Methods This retrospective study reviewed the medical records of severe OSA patients with apnea-hypopnea index (AHI) ≥ 30/hr who were diagnosed between October 1, 2008 and June 30, 2014. Patients were initially treated with 2 weeks of PAP, and those who were intolerant to high-pressure PAP (≥15 cm H2O) were switched to 12 weeks of MAD, which is a monobloc designed at 75% of maximum protrusion. Patients who had high residual AHI (≥15/hr) on MAD underwent 12 weeks of combination therapy (CT) with MAD and CPAP and were enrolled in the present study. Enrolled subjects who completed the 12-week CT were followed-up until June 30, 2016. Results A total of 14 male patients were included. All three treatments effectively reduced AHI, oxygen desaturation index (ODI), and total sleep time with SpO2 <90% (% TST-SpO2<90%) compared to pretreatment values. The residual AHI and ODI on CT was lower than that on MAD or PAP. The residual % TST-SpO2<90% was lower than that on MAD and similar to that on PAP. The therapeutic pressure on CT was on average 9.2 cm H2O lower than that on PAP. For the 11 patients who completed CT, only CT reduced ESS compared to pretreatment value. No treatment had significant impact on % slow wave sleep or overnight change of blood pressure. For patients who completed CT, the average usage was 5.9±1.7 hr/night at 12th week and 6.4±1.5 hr/night at a median follow-up of 36.5-months. Conclusions Combining MAD and CPAP showed additive effects on reducing AHI and ODI, and lowered the therapeutic pressures.
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