title: Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non-adherent to CPAP.
abstract: The aim of this retrospective study was to evaluate the effect of individually adjusted custom-made mandibular advancement device/oral appliance (OA) in treatment of patients with moderate and severe obstructive sleep apnoea (OSA), who were non-adherent to continuous positive airway pressure (CPAP) therapy. During 2007-2013, 116 patients with moderate (n = 82) and severe (n = 34) OSA non-adherent to CPAP treatment were referred for dental management with an individually adjusted OA at a specialist sleep clinic. Ten of the participants (8·6%) were lost to follow-up, leaving the data set to consist of 106 patients (71 men/35 women, mean age 57 year, range 28-90). Nocturnal respiratory polygraphic recordings were performed at baseline and follow-up. Average time between baseline polygraphy and follow-up was 12 months. A successful OA treatment outcome was based on polygraphy at the follow-up and divided into three groups: 1 = AHI <5; 2 = 5 ≤ AHI <10 and >50% reduction in baseline AHI; and 3. >50% reduction in baseline AHI. If there was a ≤ 50% reduction in baseline AHI at the follow-up, the treatment was considered as a failure. The overall treatment success rate was 75%. There was no significant difference in success rates between patients in the moderate and severe categories (69% and 77%, respectively). Low oxygen saturation (SpO2 nadir) had a high predictive value for OA treatment failure. OA treatment of patients non-adherent to CPAP is efficient and especially promising for the severe OSA group who are at greatest risks for developing serious comorbidities, if left untreated.
authors.affiliation: Department of Thoracic Medicine, Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Gjerde
authors.affiliation: Department of Thoracic Medicine, Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Science, Section for Thoracic Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Lehmann
authors.affiliation: Department of Thoracic Medicine, Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: M E
authors.initials: ME
authors.lastname: Berge
authors.affiliation: Department of Clinical Dentistry - Cariology, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: A-K
authors.initials: AK
authors.lastname: Johansson
authors.affiliation: Department of Thoracic Medicine, Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Johansson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
keywords: continuous positive airway pressure; mandibular advancement; medical device; obstructive sleep apnoea; oximetry; somnography