title: Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome.
abstract: BACKGROUND
  We sought to establish the efficacy of an adjustable oral appliance (aOA) in the largest patient population studied to date, to our knowledge, and to provide a comparison with continuous positive airway pressure (CPAP).
  
  
  METHODS
  We conducted a retrospective analysis of patients using an aOA. Results of overnight polysomnography with aOA titration were evaluated and compared with CPAP. Predictors of a successful aOA titration were determined using a multivariate logistic regression model.
  
  
  RESULTS
  A total of 497 patients were given an aOA during the specified time period. The aOA reduced the mean apnea-hypopnea index (AHI) to 8.4 ± 11.4, and 70.3%, 47.6%, and 41.4% of patients with mild, moderate, and severe disease achieved an AHI < 5, respectively. Patients using an aOA decreased their mean Epworth Sleepiness Score by 2.71 (95% CI, 2.3-3.2; P < .001) at follow-up. CPAP improved the AHI by -3.43 (95% CI, 1.88-4.99; P < .001) when compared with an aOA, but when adjusted for severity of disease, this difference only reached significance for patients with severe disease (-5.88 [95% CI, -8.95 to -2.82; P < .001]). However, 70.1% of all patients achieved an AHI < 5 using CPAP compared with 51.6% for the aOA (P < .001). On multivariate analysis, baseline AHI was a significant predictor of achieving an AHI < 5 on aOA titration, and age showed a trend toward significance.
  
  
  CONCLUSIONS
  In comparison with past reports, more patients in our study achieved an AHI < 5 using an aOA. The aOA is comparable to CPAP for patients with mild disease, whereas CPAP is superior for patients with moderate to severe disease. A lower AHI was the only predictor of a successful aOA titration.
authors.affiliation: Department of Pulmonary/Sleep and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: aholley9@gmail.com.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Holley
authors.affiliation: Department of Pulmonary/Sleep and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lettieri
authors.affiliation: Pulmonary and Critical Care Department, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Anita A
authors.initials: AA
authors.lastname: Shah
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation; D008875:Middle Aged; D015999:Multivariate Analysis; D009968:Orthodontic Appliances, Removable; D010349:Patient Compliance; D017060:Patient Satisfaction; D017286:Polysomnography / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome