title: Prevalence of residual excessive sleepiness during effective oral appliance therapy for sleep-disordered breathing.
abstract: BACKGROUND
  Oral appliance therapy with a mandibular advancement device (OAm) can yield to complete therapeutic response (apnea-hypopnea index [AHI]<5 events/h), though some patients show little or no improvement in daytime sleepiness. The prevalence of residual excessive sleepiness (RES) despite effective treatment with OAm therapy is unknown. We aimed to determine the prevalence of RES in patients treated with a titratable custom-made duobloc OAm.
  
  
  METHODS
  A prevalence study was performed, collecting data from 185 patients with an established diagnosis of sleep-disordered breathing (SDB) under OAm therapy with a titratable custom-made duobloc device (baseline data were male:female ratio, 129:56; age, 48±9 years; body mass index [BMI], 27±4 kg/m2; Epworth Sleepiness Scale [ESS] score, 10±5; and AHI, 19±12 events/h). A full-night polysomnography was performed at baseline and after 3 months of OAm therapy. Daytime sleepiness was assessed using the ESS with RES defined as an ESS score of 11 or higher out of 24, despite complete therapeutic response.
  
  
  RESULTS
  Out of 185 patients, 84 patients (45%) showed a complete therapeutic response with an AHI of <5 events per hour after 3 months of OAm therapy. Despite this normalization of AHI, 27 out of these 84 patients (32%) showed RES and had a significantly higher baseline ESS (15±4 vs. 9±4; P<.001) and were younger (43±9 vs. 47±9; P=.028) compared to patients without RES.
  
  
  CONCLUSIONS
  RES under OAm therapy showed a prevalence of up to 32% in SDB patients effectively treated with respect to AHI. Patients with RES were younger and had higher baseline daytime sleepiness.
authors.affiliation: ENT Department and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. Electronic address: annelies.verbruggen@uza.be.
authors.forename: A E R
authors.initials: AE
authors.lastname: Verbruggen
authors.affiliation: ENT Department and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Department of Special Care Dentistry, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Dieltjens
authors.affiliation: Scientific Coordination and Biostatistics, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Wouters
authors.affiliation: Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium; Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: De Volder
authors.affiliation: ENT Department and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: P H
authors.initials: PH
authors.lastname: Van de Heyning
authors.affiliation: Department of Special Care Dentistry, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: M J
authors.initials: MJ
authors.lastname: Braem
authors.affiliation: ENT Department and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: O M
authors.initials: OM
authors.lastname: Vanderveken
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D009968:Orthodontic Appliances, Removable; D015995:Prevalence; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
keywords: Daytime sleepiness; Dental sleep medicine; Epworth Sleepiness Scale; Mandibular advancement device; Obstructive sleep apnea; Sleep disordered breathing