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Chest. 2011 Dec;140(6):1511-1516. doi: 10.1378/chest.10-2851. Epub 2011 Jun 2.

Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome.

Author information

1
Department of Pulmonary/Sleep and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: aholley9@gmail.com.
2
Department of Pulmonary/Sleep and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
3
Pulmonary and Critical Care Department, Madigan Army Medical Center, Tacoma, WA.

Abstract

BACKGROUND:

We sought to establish the efficacy of an adjustable oral appliance (aOA) in the largest patient population studied to date, to our knowledge, and to provide a comparison with continuous positive airway pressure (CPAP).

METHODS:

We conducted a retrospective analysis of patients using an aOA. Results of overnight polysomnography with aOA titration were evaluated and compared with CPAP. Predictors of a successful aOA titration were determined using a multivariate logistic regression model.

RESULTS:

A total of 497 patients were given an aOA during the specified time period. The aOA reduced the mean apnea-hypopnea index (AHI) to 8.4 ± 11.4, and 70.3%, 47.6%, and 41.4% of patients with mild, moderate, and severe disease achieved an AHI < 5, respectively. Patients using an aOA decreased their mean Epworth Sleepiness Score by 2.71 (95% CI, 2.3-3.2; P < .001) at follow-up. CPAP improved the AHI by -3.43 (95% CI, 1.88-4.99; P < .001) when compared with an aOA, but when adjusted for severity of disease, this difference only reached significance for patients with severe disease (-5.88 [95% CI, -8.95 to -2.82; P < .001]). However, 70.1% of all patients achieved an AHI < 5 using CPAP compared with 51.6% for the aOA (P < .001). On multivariate analysis, baseline AHI was a significant predictor of achieving an AHI < 5 on aOA titration, and age showed a trend toward significance.

CONCLUSIONS:

In comparison with past reports, more patients in our study achieved an AHI < 5 using an aOA. The aOA is comparable to CPAP for patients with mild disease, whereas CPAP is superior for patients with moderate to severe disease. A lower AHI was the only predictor of a successful aOA titration.

PMID:
21636666
DOI:
10.1378/chest.10-2851
[Indexed for MEDLINE]

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