title: A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea.
abstract: OBJECTIVE
  To compare efficacy, side effects, patient compliance, and preference between oral appliance (OA) therapy and nasal-continuous positive airway pressure (N-CPAP) therapy.
  
  
  METHODS
  Randomized, prospective, crossover study.
  
  
  METHODS
  University hospital and tertiary sleep referral center.
  
  
  METHODS
  Twenty-seven unselected patients with mild-moderate obstructive sleep apnea (OSA).
  
  
  METHODS
  There was a 2-week wash-in and a 2-week wash-out period, and 2 x 4-month treatment periods (OA and N-CPAP). Efficacy, side effects, compliance, and preference were evaluated by a questionnaire and home sleep monitoring.
  
  
  RESULTS
  Two patients dropped out early in the study and treatment results are presented on the remaining 25 patients. The apnea/hypopnea index was lower with N-CPAP (3.5 +/- 1.6) (mean +/- SD) than with the OA (9.7 +/- 7.3) (p < 0.05). Twelve of the 25 patients who used the OA (48%) were treatment successes (reduction of apnea/hypopnea to <10/h and relief of symptoms), 6 (24%) were compliance failures (unable or unwilling to use the treatment), and 7 (28%) were treatment failures (failure to reduce apnea/hypopnea index to <10/h and/or failure to relieve symptoms). Four people refused to use N-CPAP after using the OA. Thirteen of the 21 patients who used N-CPAP were overall treatment successes (62%), 8 were compliance failures (38%), and there were no treatment failures. Side effects were more common and the patients were less satisfied with N-CPAP (p < 0.005). Seven patients were treatment successes with both treatments, six of these patients preferred OA, and one preferred N-CPAP as a long-term treatment.
  
  
  CONCLUSIONS
  We conclude that OA is an effective treatment in some patients with mild-moderate OSA and is associated with fewer side effects and greater patient satisfaction than N-CPAP.
authors.affiliation: Department of Clinical Dental Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: K A
authors.initials: KA
authors.lastname: Ferguson
authors.forename: T
authors.initials: T
authors.lastname: Ono
authors.forename: A A
authors.initials: AA
authors.lastname: Lowe
authors.forename: S P
authors.initials: SP
authors.lastname: Keenan
authors.forename: J A
authors.initials: JA
authors.lastname: Fleetham
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017090:Occlusal Splints / Q000009:adverse effects; D017060:Patient Satisfaction; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000628:therapy*