title: Determinants of Objective Compliance During Oral Appliance   Therapy in Patients With Sleep-Disordered Breathing:   A Prospective Clinical Trial.
abstract: OBJECTIVE
  The main reported reasons for discontinuation of oral appliance therapy for sleep-disordered breathing (SDB) are the presence of self-perceived adverse effects and self-appreciated lack of efficacy. However, these conclusions rely only on subjective compliance data.
  
  
  OBJECTIVE
  To determine which parameters are correlated with objectively measured data on compliance with oral appliance therapy.
  
  
  METHODS
  For 51 outpatients with SDB, a prospective clinical trial using oral appliance therapy was conducted at Antwerp University Hospital from February 7, 2011, to October 8, 2013 (38 [75%] males; mean [SD] age, 49.3 [9.0] years; mean [SD] apnea-hypopnea index, 14.9 [9.3] events per hour of sleep; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 26.3 [2.8]). Analysis was performed November 5, 2014.
  
  
  METHODS
  Oral appliance therapy with a custom-made, titratrable mandibular advancement device (OAm).
  
  
  METHODS
  Possible correlations were assessed between objective compliance and patients’ anthropometric characteristics, polysomnographic parameters, and answers to 3 subjective questionnaires (the visual analog scale for snoring, the Epworth Sleepiness Scale, and an adverse effects questionnaire).
  
  
  RESULTS
  Median oral appliance use was 6.4 hours per night (range, 4.7-7.2 hours per night) at the 3-month follow-up. None of the anthropometric and polysomnographic parameters were correlated with compliance. No correlation was found between objective compliance and reports of excessive daytime sleepiness. However, a significant inverse correlation was found between objective compliance and posttreatment visual analog scale values for snoring (P = .006; ρ = –.40). In addition, objective compliance was correlated significantly with a more pronounced decrease in socially disturbing snoring (P = .005; ρ = 0.39). The presence of dry mouth was the only adverse effect that was negatively correlated with objective compliance at the 3-month follow-up (P < .05; ρ = –.31).
  
  
  CONCLUSIONS
  Neither the anthropometric and polysomnographic parameters nor reports of excessive daytime sleepiness correlated with compliance during oral appliance therapy. The 2 parameters that were correlated with higher objective compliance during oral appliance therapy were a more pronounced decrease in snoring and the presence of dry mouth during treatment.
  
  
  BACKGROUND
  clinicaltrials.gov Identifiers: NCT01284881 and NCT01532050.
authors.forename: Marijke
authors.initials: M
authors.lastname: Dieltjens
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Verbruggen
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Braem
authors.forename: Kristien
authors.initials: K
authors.lastname: Wouters
authors.forename: Johan A
authors.initials: JA
authors.lastname: Verbraecken
authors.forename: Wilfried A
authors.initials: WA
authors.lastname: De Backer
authors.forename: Evert
authors.initials: E
authors.lastname: Hamans
authors.forename: Paul H
authors.initials: PH
authors.lastname: Van de Heyning
authors.forename: Olivier M
authors.initials: OM
authors.lastname: Vanderveken
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects / Q000295:instrumentation*; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000523:psychology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome