Determinants of Objective Compliance During Oral Appliance Therapy in Patients With Sleep-Related Disordered Breathing

Dieltjens, Marijke; Verbruggen, Annelies E.; Braem, M; Wouters, Kristien; Verbraecken, Johan; Backer, Wilfried A. De; Hamans, Evert; Heyning, Paul Van de; Vanderveken, Olivier M.

doi:10.1001/jamaoto.2015.1756

Cited by 48 publications

(47 citation statements)

References 40 publications

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“…With the advent of objective monitoring, in two prospective small-scale studies, a median use of MAD therapy for 6.4 h/night was reported after 3 months and a mean use of 6.1 h/night after 1 year. 52,53 Approximately 29% to 83% of patients using CPAP are noncompliant.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Ravesloot¹,

White

Heinzer

et al. 2017

Journal of Clinical Sleep Medicine

108

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Study Objectives:In approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position. This is referred to as position-dependent OSA or POSA. Patients with POSA can be treated with a small device attached to either the neck or chest. These devices-a new generation of devices for positional therapy (PT)-provide a subtle vibrating stimulus that prevents patients adopting the supine position. The objectives of this study were to determine whether PT is effective in improving sleep study variables and sleepiness, and to assess compliance. Methods: A systematic review and meta-analysis. Results: Three prospective cohort studies and four randomized controlled trials were included in this review. Combined data for studies reporting on the effect of PT show that there was a mean difference of 11.3 events/h (54% reduction) in apnea-hypopnea index and 33.6% (84% reduction) in percentage total sleeping time in the supine position. The standardized mean difference for both parameters demonstrated a large magnitude of effect (> 0.8 in both cases). Conclusions: There is strong evidence that the new generation of devices for PT are effective in reducing the apnea-hypopnea index during short-term follow-up. These devices are simple-to-use for patients and clinicians and are reversible. Under study conditions with short-term follow-up, compliance is high; however, long-term compliance cannot be assessed because of lack of reliable data. Additional long-term, high-quality studies are needed to confirm the role of PT as a single or as a combination treatment modality for OSA patients and to assess long-term compliance. Keywords: compliance, meta-analysis, obstructive sleep apnea, positional, positional therapy, systematic review Citation: Ravesloot MJ, White D, Heinzer R, Oksenberg A, Pépin JL. Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med. 2017;13(6):813-824. I NTRO DUCTI O NIn approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position.1-5 Various definitions of positiondependent obstructive sleep apnea (POSA) have been applied in literature, but the most common classification system and definition marks a distinction between two groups of patients: positional patients (PP) 6 and nonpositional patients (NPP). 3,4,7In PP, desaturations, cyclic variations in heart rate, loud snoring, and apneas and hypopneas appear almost exclusively in the supine position. 8 Cartwright first described the arbitrary cutoff point of a difference of 50% or more in apnea index between supine and nonsupine positions. In the medical literature many have applied modified versions of Cartwright's criteria. In 1998, Marklund et al. defined supine-dependent sleep apnea as a supine apnea-hypopnea index (AHI) ≥ 10 events/h, together with a lateral AHI < 10 ev...

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Section: Discussionmentioning

confidence: 99%

Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Ravesloot¹,

White

Heinzer

et al. 2017

Journal of Clinical Sleep Medicine

108

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“…4 Objective measurements of OA usage after 3 months of OA treatment ranged from a mean of 6.4 hours to 6.6 hours per night. 35,36 A meta-analysis of 6 studies encompassing both subjective and objective MAD compliance measures reported an additional 1.1 hours per night use of MAD over CPAP. 33 A majority of crossover trials report that MADs are preferred to CPAP, which may imply better patient compliance with MADs.…”

Section: Oxygenationmentioning

confidence: 99%

“…46,48 ORAL APPLIANCE ADVERSE EFFECTS Similar to efficacy, adverse side effects have a dose-dependent relationship with protrusion. 29 A balance must be struck between efficacy and side effects because more adverse effects reduce long-term compliance, 35,49 resulting in patients terminating MAD therapy. 50,51 Most adverse effects caused by MADs are mild and transient, occur during the initial phase of therapy, and tend to resolve with time.…”

Section: Cardiovascular Effectsmentioning

confidence: 99%

“…Other MAD side effects include increased salivation, more frequent and excessive dry mouth, tongue discomfort, and a sense of suffocation. 3,35,51 TSD side effects include excess salivation, drooling, dry mouth, and soft tissue irritation. 3…”

Section: Other Effectsmentioning

confidence: 99%

“…51,52 Close monitoring and coaching through the initial period may improve compliance. 35,50,51 For initial comfort, mandibular advancement is 75% of maximum protrusion. 1 Clinical titration with an adaptation period increases the achievable protrusion and improves treatment response.…”

Section: Clinical Follow-upmentioning

confidence: 99%

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Oral Appliances in the Management of Obstructive Sleep Apnea

Yow

2019

Sleep Medicine Clinics

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Airway imaging with cone-beam computed tomography, magnetic resonance imaging and nasal endoscopy showed anteroposterior (AP) mandibular protrusion predominantly increases the caliber of the airway at the retropalatal area via lateral expansion and displacement of parapharyngeal fat pads 2,6-13 while the tongue and tongue-base muscles shift forward. 2,9,13 The lateral widening from AP movement is attributed to stretching of soft tissue connections KEYWORDS OSA Oral appliance Mandibular advancement Tongue stabilizer KEY POINTSThe concept in oral appliances for obstructive sleep apnea (OSA) management is protrusion of the mandible and/or tongue for structural effects on the upper airway. The upper airway is a muscular tube and its dimensions are enlarged with mandibular and tongue advancement. Protrusion of the mandible and tongue stretches the muscles, thereby reducing upper airway collapsibility with airway shape change and increase in muscle tone. Oral appliances are effective and evidence-based options in managing OSA.

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Adjustable thermoplastic oral appliance versus positive airway pressure for obstructive sleep apnea

et al. 2017

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Determinants of Objective Compliance During Oral Appliance Therapy in Patients With Sleep-Related Disordered Breathing

Abstract: clinicaltrials.gov Identifiers: NCT01284881 and NCT01532050.

Cited by 48 publications

References 40 publications

Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Oral Appliances in the Management of Obstructive Sleep Apnea

Adjustable thermoplastic oral appliance versus positive airway pressure for obstructive sleep apnea

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