title: Assessment of interfering factors in non-adherence to oral appliance therapy in severe sleep apnea.
abstract: OBJECTIVE
  Oral appliances (OA) are recommended for patients with severe obstructive sleep apnea who fail to comply with continuous positive airway pressure (CPAP) therapy. This mixed-methods study aimed to quantify adherence to OA therapy and evaluate subjective reasons associated with non-adherence.
  
  
  METHODS
  The medical records of 52 patients with an apnea-hypopnea index (AHI) ≥ 40, treated with OA after discontinuation of CPAP treatment, were examined for OA adherence. Patients were divided according to usage at the time of a phone interview. The USER group included all forms of usage, whereas those who completely ceased using the OA were in the NUSE group. The timing of the phone interview was from five months to six years (average 44.63 ± 17.17 months) after OA delivery.
  
  
  RESULTS
  The overall adherence rate was 57.7% (30/52 patients). The mean usage times were 10.07 ± 8.96 and 44.30 ± 17.3 months in the NUSE and NUSE groups, respectively. The main factors associated with non-adherence were concerns about the effects of the OA on teeth (22%) and insufficient efficacy (22%). Other factors were discomfort (15%) and improved well-being following weight loss (15%). The overall number of interfering and discontinuity factors was significantly higher in the NUSE group than in the USER group (P = 0.041). Nine (17.3%) of 52 patients resumed CPAP use. Subjective and objective outcomes, determined by using a second sleep test with OA in 69.2% of patients, were related to the continuation of treatment.
  
  
  CONCLUSIONS
  On-adherence to OA is strongly associated with patient reservations regarding the effects of the device on teeth, possible lack of efficacy, and discomfort. Clinicians should closely monitor adherence patterns and assess potential interfering factors during their diagnostic workup. Patients should be reassured regarding device safety, particularly following dental work that may interfere with the insertion of the OA.
authors.affiliation: Department of Oral Medicine, Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Y
authors.identifier: http://orcid.org/0000-0001-9421-615X
authors.initials: Y
authors.lastname: Haviv
authors.affiliation: Department of Community Dentistry, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Zini
authors.affiliation: Department of Oral Medicine, Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.|Department of Oral Medicine, Oral and Maxillofacial Center, Tel-Hashomer, Medical Corps, Israel Defence Forces, Jerusalem, Israel.
authors.forename: G
authors.identifier: http://orcid.org/0000-0001-9671-0047
authors.initials: G
authors.lastname: Almoznino
authors.affiliation: Department of Oral Medicine, Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Keshet
authors.affiliation: Department of Oral Medicine, Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Sharav
authors.affiliation: Department of Oral Medicine, Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: D J
authors.initials: DJ
authors.lastname: Aframian
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects / Q000295:instrumentation; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D013997:Time Factors
keywords: adherence; obstructive sleep apnea; oral appliance; snoring