title: Oral appliance in sleep apnea treatment: respiratory and clinical effects and long-term adherence.
abstract: OBJECTIVE
  There is an increasing tendency to use oral appliance (OA) as an alternative treatment for sleep apnea. Here we report the long-term adherence and clinical effects of OA therapy.
  
  
  METHODS
  All sleep apnea patients treated at the Department of Dentistry between the years 2006 and 2013 (n = 1208) were reviewed. A questionnaire about OA adherence, asthma symptoms (Asthma Control Test™, ACT), and general health was sent to all patients who continued OA therapy after the 1-month follow-up visit (n = 811). OA was adjusted to obtain at least 70 % of the maximal protrusion of the mandible.
  
  
  RESULTS
  The response rate was 37.4 % (99 women, 204 men). The mean ± SD age and BMI were 58.7 ± 10.3 years and 27.3 ± 4.0 kg/m(2), respectively. During the mean follow-up period of 3.3 years, there was no significant variation in BMI. Forty-one patients abandoned OA therapy yielding an adherence rate of 86 %. Ninety-seven percent of patients used OA ≥4 h/day, and the mean daily use was 7.2 ± 1.1 h. The ACT score improved with OA use from 16.0 ± 5.9 to 20.1 ± 3.8 (p = 0.004), indicating better asthma control. The apnea and hypopnea index decreased significantly from 27 ± 19 at baseline to 10 ± 10 with OA therapy (p = 0.001).
  
  
  CONCLUSIONS
  After a 1-month trial period, the long-term adherence to oral appliance was good. OA therapy decreased apneas and hypopneas significantly, and its long-term use was associated with an improvement in respiratory and asthma symptoms.
authors.affiliation: Heart and Lung Center, Sleep Unit, University of Helsinki and Helsinki University Hospital, P.O.BOX 160, FI-00029, HUS Helsinki, Finland. patrick.bachour@helsinki.fi.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bachour
authors.affiliation: Heart and Lung Center, Sleep Unit, University of Helsinki and Helsinki University Hospital, P.O.BOX 160, FI-00029, HUS Helsinki, Finland.
authors.forename: Adel
authors.initials: A
authors.lastname: Bachour
authors.affiliation: Inflammation Center, Allergy Department, University of Helsinki and Helsinki University Hospital, P.O.BOX 160, FI-00029, HUS Helsinki, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Kauppi
authors.affiliation: Heart and Lung Center, Sleep Unit, University of Helsinki and Helsinki University Hospital, P.O.BOX 160, FI-00029, HUS Helsinki, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Maasilta
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O.BOX 160, FI-00029, HUS Helsinki, Finland.|Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Antti
authors.initials: A
authors.lastname: Mäkitie
authors.affiliation: Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Palotie
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care / Q000523:psychology*; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D017090:Occlusal Splints; D010349:Patient Compliance / Q000523:psychology*; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000523:psychology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Asthma; Oral sleep apnea appliance; Questionnaire; Sleep study