title: A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea: a cohort study.
abstract: OBJECTIVE
  Oral appliances for treating severe obstructive sleep apnea (OSA) are recommended for patients who failed to comply with continuous positive airway pressure (CPAP) treatment. The objective of this study was to evaluate medium long-term outcome and success rates of oral appliances in patients with severe OSA.
  
  
  METHODS
  In a retrospective study, 52 OSA patients with an apnea-hypopnea index (AHI) ≥40, who did not tolerate CPAP treatment, were enrolled and fitted with a modified Herbst oral appliance. A 2-year mean follow-up including a second somnography was conducted in 36 of the patients.
  
  
  RESULTS
  A significant reduction (P < 0.0001) in the AHI was demonstrated between the initial somnography (55.25 ± 10.79,) and the followed one (17.74 ± 11.0, n = 36). Overall, 57.7% of total study subjects (n = 52) and 63.9% (n = 36) that had sequential sonmogarphy continued using the device. The reduction in AHI in the user group was 42.4 ± 3.1 (n = 23), which was significantly higher (P = 0.013) than in the non-user group (28.9 ± 17.2; n = 13). Moreover, 53% (n = 19) reached AHI of <15.
  
  
  CONCLUSIONS
  Oral appliances were found to be successful for treating for severe OSA after first-line treatment had failed.
authors.affiliation: Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Haviv
authors.forename: G
authors.initials: G
authors.lastname: Bachar
authors.forename: D J
authors.initials: DJ
authors.lastname: Aframian
authors.forename: G
authors.initials: G
authors.lastname: Almoznino
authors.forename: E
authors.initials: E
authors.lastname: Michaeli
authors.forename: R
authors.initials: R
authors.lastname: Benoliel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D019736:Prostheses and Implants; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D013997:Time Factors
keywords: apnea hypopnea index; continuous positive airway pressure; dental appliance; obstructive sleep apnea; oral appliance