title: Predictors of long-term effectiveness to mandibular repositioning device treatment in obstructive sleep apnea patients after 1000 days.
abstract: In obstructive sleep apnea (OSA), long-term adherence to treatment is crucial. This prospective single-center study investigated factors associated with long-term adherence to mandibular repositioning device (MRD) therapy.
  
  
  
  All OSA patients who had MRD treatment initiated in the previous year were prospectively contacted to evaluate long-term effectiveness and compliance. Long-term adherence was based on continuation of treatment (yes/no). Predictors of long-term adherence were analyzed using an adjusted multivariate analysis.
  
  
  
  Median follow-up was 1002 days (interquartile range: 668-1345) in 279 patients (age 58 [50-64] years); 63% of patients were continuing MRD treatment with a good efficacy, tolerability and compliance over time. In some patients, relapse of nocturia was observed while efficacy was maintained for snoring and somnolence. In adjusted multivariate analysis, significant predictors of continuing MRD treatment were early ≥50% reduction in AHI (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.466-5.10; p = 0.0002) and complete symptom resolution (OR 3.83, 95% CI 1.74-8.48; p = 0.0014). In the 37% of patients who stopped MRD treatment, median treatment duration was 351 (174-752) days. The main reasons for late stopping of treatment were inefficacy (26.2%), discomfort (25.2%) and side effects (21.4%).
  
  
  
  After three years, MRD was effective for the two-thirds of OSA patients who continued treatment. Relapse of nocturia might be an early signal of MRD wear that may explain long-term cessation of treatment in some patients. Short-term control of OSA by MAD was predictive of long-term efficiency. The major criteria were a ≥50% reduction in AHI and complete symptom resolution at short-term evaluation.
authors.affiliation: Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service d'Exploration des Pathologies du Sommeil (Département "R3S"), 47-83 boulevard de l'hôpital, 75013 Paris, France. Electronic address: valerie.attali@aphp.fr.
authors.forename: Valérie
authors.initials: V
authors.lastname: Attali
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service d'Exploration des Pathologies du Sommeil (Département "R3S"), 47-83 boulevard de l'hôpital, 75013 Paris, France. Electronic address: charlotte.chaumereuil@gmail.com.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Chaumereuil
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service d'Exploration des Pathologies du Sommeil (Département "R3S"), 47-83 boulevard de l'hôpital, 75013 Paris, France. Electronic address: isabelle.arnulf@aphp.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnulf
authors.affiliation: Department of Biostatistics, Pitié-Salpêtrière Hospital, ER4, Sorbonne Universités, UPMC Université Paris 06, 47-83 boulevard de l'hôpital, 75013 Paris, France. Electronic address: jea-louis.golmard@aphp.fr.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Golmard
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service d'Exploration des Pathologies du Sommeil (Département "R3S"), 47-83 boulevard de l'hôpital, 75013 Paris, France. Electronic address: fabienne_tordjman@hotmail.com.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Tordjman
authors.affiliation: ResMed Science Center, 292 allée Jacques Monod, 69791 Saint Priest Cedex, France. Electronic address: laurent.morin@resmed.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Morin
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-faciale, 47-83 boulevard de l'hôpital, 75013 Paris, France. Electronic address: patrick.goudot@aphp.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goudot
authors.affiliation: Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), 47-83 boulevard de l'hôpital, 75013 Paris, France. Electronic address: thomas.similowski@aphp.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-faciale, 47-83 boulevard de l'hôpital, 75013 Paris, France. Electronic address: jean-marc.collet@aphp.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Collet
mesh_terms: D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008334:Mandible; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance; D011379:Prognosis; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome
keywords: Efficacy; Mandibular repositioning device; Obstructive sleep apnea; Predictors of long-term adherence; Tolerance