title: A promising concept of combination therapy for positional obstructive sleep apnea.
abstract: OBJECTIVE
  The objective of this randomized controlled trial was to assess the additional effect of a chest-worn sleep position trainer (SPT) in patients with residual supine-dependent obstructive sleep apnea (sdOSA) under mandibular advancement device (MAD) therapy.
  
  
  METHODS
  Baseline and follow-up polysomnography with MAD were performed. Twenty patients with sdOSA under MAD therapy underwent two consecutive randomized polysomnographies: one with SPT and one with combination of SPT + MAD. Data are presented as median (quartile 1, quartile 3).
  
  
  RESULTS
  The SPT reduced the time spent in supine sleeping position compared to baseline and MAD therapy. Both MAD and SPT were individually effective in reducing the overall apnea/hypopnea index (AHI) significantly when compared to baseline from 20.8 (15.1; 33.6)/h at baseline to 11.0 (6.7; 13.8)/h and to 11.1 (3.5; 17.7)/h with MAD or SPT, respectively. The combination of SPT + MAD further reduced the overall AHI to 5.7 (3.6; 7.4), which was significantly lower than with MAD alone (p < 0.001) and SPT alone (p < 0.008), respectively.
  
  
  CONCLUSIONS
  The results of this study indicate that combination of SPT + MAD leads to a higher therapeutic efficacy in patients with sdOSA under MAD therapy when compared to one of the treatment modalities alone.
authors.affiliation: Department of Special Care Dentistry, Antwerp University Hospital (UZA), Wilrijkstraat 10, 2650, Edegem, Belgium, Marijke.Dieltjens@uza.be.
authors.forename: Marijke
authors.initials: M
authors.lastname: Dieltjens
authors.forename: Anneclaire V
authors.initials: AV
authors.lastname: Vroegop
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Verbruggen
authors.forename: Kristien
authors.initials: K
authors.lastname: Wouters
authors.forename: Marc
authors.initials: M
authors.lastname: Willemen
authors.forename: Wilfried A
authors.initials: WA
authors.lastname: De Backer
authors.forename: Johan A
authors.initials: JA
authors.lastname: Verbraecken
authors.forename: Paul H
authors.initials: PH
authors.lastname: Van de Heyning
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Braem
authors.forename: Nico
authors.initials: N
authors.lastname: de Vries
authors.forename: Olivier M
authors.initials: OM
authors.lastname: Vanderveken
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D017090:Occlusal Splints; D056888:Patient Positioning / Q000295:instrumentation*; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*; D016683:Supine Position / Q000502:physiology*