title: Effectiveness of Oral Appliances in Obstructive Sleep Apnea with Respiratory Arousals.
abstract: To compare adherence and treatment effects with an oral appliance (OA) in patients with different types of obstructive sleep apnea (OSA): those with mainly respiratory arousals ("arousers"), and those with oxygen desaturations ("desaturaters") at polysomnography (PSG).
  
  
  
  A prospective intervention study on 72 "tired snorers" with "normal" home sleep study (HSS), but later diagnosed as OSA with PSG, who accepted OA treatment. They were offered evaluation with a follow-up PSG and questionnaires, including the Epworth Sleepiness Scale (ESS), general health (GH), satisfaction, and side effects.
  
  
  
  Sixty-six patients, 33 arousers and 33 desaturaters, were adapted to OA. The 1-year adherence rate was significantly higher among arousers (85%) than desaturaters (55%) (p = 0.034). Thirty-six of 66 patients underwent follow-up PSG; the apnea-hypopnea index was significantly reduced in 22 arousers from a median of 14 to 3 (p < 0.001), and in 14 desaturaters from 18 to 7 (p = 0.002; no significant group difference). ESS and GH showed no significant improvements in either group, although sleepy "arousers" (ESS ≥ 10) significantly improved their ESS. In total, 77% reported side effects, while 63% were still satisfied with the OA treatment. Gender analysis showed a significant dominance of females classified as "arousers" (p = 0.025).
  
  
  
  OSA patients with mainly arousals at PSG showed higher adherence to OA treatment, compared to patients with desaturations. Both groups responded similarly to treatment: improved nocturnal respiration, but only a small reduction of symptoms. We suggest that "tired snorers" with "normal HSS" should be offered PSG, and if OSA, also OA treatment.
authors.affiliation: Karolinska Institute Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Stockholm, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Nerfeldt
authors.affiliation: Karolinska Institute Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Stockholm, Sweden.
authors.forename: Danielle
authors.initials: D
authors.lastname: Friberg
mesh_terms: D000328:Adult; D000368:Aged; D001143:Arousal / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011446:Prospective Studies; D012137:Respiratory System / Q000503:physiopathology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: apnea; dental device; obstructive sleep apnea; oral appliance; sleep; upper airway resistance syndrome