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CC BY 4.0 · Eur J Dent 2022; 16(04): 749-755
DOI: 10.1055/s-0040-1719220
Original Article

Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

Thyagaseely Sheela Premaraj
1   Department of Orthodontics, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, United States
,
Jacob Stadiem
2   Department of Orthodontics, University of Nebraska Medical Center, Lincoln, Nebraska, United States
,
Shyamaly Arya Premaraj
3   College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, United States
,
Charles R. Davies
4   Carle Neuroscience Institute, Carle Physician Group, University of Illinois at Urbana, Illinois, United States
,
Matthew Dennis
5   Division of Pediatric Pulmonology & Sleep Medicine, University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha, Nebraska, United States
,
John J. Harrington
6   Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
› Author Affiliations Funding This research was funded by DH Reinhardt Scholarship, College of Dentistry, University of Nebraska Medical Center. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
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Abstract

Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks.

Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study.

Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance.

Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference.

Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

Keywords

auto-adjusting positive airway pressure - Epworth Sleepiness Scale scores - mandibular advancement device - obstructive sleep apnea


Publication History

Article published online:
07 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Leinum CJ, Dopp JM, Morgan BJ. Sleep-disordered breathing and obesity: pathophysiology, complications, and treatment. Nutr Clin Pract 2009; 24 (06) 675-687
    CrossrefPubMedGoogle Scholar
  • 2 Stansbury RC, Strollo PJ. Clinical manifestations of sleep apnea. J Thorac Dis 2015; 7 (09) E298-E310
    PubMedGoogle Scholar
  • 3 Serra-Torres S, Bellot-Arcís C, Montiel-Company JM, Marco-Algarra J, Almerich-Silla JM. Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: a systematic review. Laryngoscope 2016; 126 (02) 507-514
    CrossrefPubMedGoogle Scholar
  • 4 Kushida CA, Morgenthaler TI, Littner MR. et al. American Academy of Sleep. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 2006; 29 (02) 240-243
    CrossrefPubMedGoogle Scholar
  • 5 Gay P, Weaver T, Loube D, Iber C. Positive Airway Pressure Task Force. Standards of Practice Committee American Academy of Sleep Medicine. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep 2006; 29 (03) 381-401
    CrossrefPubMedGoogle Scholar
  • 6 Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 2007; 11 (01) 1-22
    CrossrefPubMedGoogle Scholar
  • 7 Lee CH, Kim JW, Lee HJ. et al. An investigation of upper airway changes associated with mandibular advancement device using sleep video fluoroscopy in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 2009; 135 (09) 910-914
    CrossrefPubMedGoogle Scholar
  • 8 Ramar K, Dort LC, Katz SG. et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015; 11 (07) 773-827
    CrossrefPubMedGoogle Scholar
  • 9 Gagnadoux F, Fleury B, Vielle B. et al. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J 2009; 34 (04) 914-920
    CrossrefPubMedGoogle Scholar
  • 10 Kribbs NB, Pack AI, Kline LR. et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 1993; 147 (04) 887-895
    CrossrefPubMedGoogle Scholar
  • 11 Ulander M, Johansson MS, Ewaldh AE, Svanborg E, Broström A. Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence. Sleep Breath 2014; 18 (04) 799-807
    CrossrefPubMedGoogle Scholar
  • 12 Lewis KE, Seale L, Bartle IE, Watkins AJ, Ebden P. Early predictors of CPAP use for the treatment of obstructive sleep apnea. Sleep 2004; 27 (01) 134-138
    CrossrefPubMedGoogle Scholar
  • 13 El-Solh AA, Moitheennazima B, Akinnusi ME, Churder PM, Lafornara AM. Combined oral appliance and positive airway pressure therapy for obstructive sleep apnea: a pilot study. Sleep Breath 2011; 15 (02) 203-208
    CrossrefPubMedGoogle Scholar
  • 14 Schwab RJ, Badr SM, Epstein LJ. et al. ATS Subcommittee on CPAP Adherence Tracking Systems. An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med 2013; 188 (05) 613-620
    CrossrefPubMedGoogle Scholar
  • 15 Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992; 15 (04) 376-381
    CrossrefPubMedGoogle Scholar
  • 16 Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J 2008; 15 (07) 365-369
    CrossrefPubMedGoogle Scholar
  • 17 Shete CS, Bhad WA. Three-dimensional upper airway changes with mandibular advancement device in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2017; 151 (05) 941-948
    CrossrefPubMedGoogle Scholar
  • 18 Ayas NT, Patel SR, Malhotra A. et al. Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis. Sleep 2004; 27 (02) 249-253
    CrossrefPubMedGoogle Scholar
  • 19 Chiu HY, Chen PY, Chuang LP. et al. Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: a bivariate meta-analysis. Sleep Med Rev 2017; 36: 57-70
    CrossrefPubMedGoogle Scholar
  • 20 Desai H, Patel A, Patel P, Grant BJ, Mador MJ. Accuracy of autotitrating CPAP to estimate the residual apnea-hypopnea index in patients with obstructive sleep apnea on treatment with autotitrating CPAP. Sleep Breath 2009; 13 (04) 383-390
    CrossrefPubMedGoogle Scholar
  • 21 Lebret M, Arnol N, Martinot J-B. et al. Determinants of unintentional leaks during CPAP treatment in OSA. Chest 2018; 153 (04) 834-842
    CrossrefPubMedGoogle Scholar
  • 22 Borel JC, Tamisier R, Dias-Domingos S. et al. Scientific Council of The Sleep Registry of the French Federation of Pneumology (OSFP). Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One 2013; 8 (05) e64382
    CrossrefPubMedGoogle Scholar
  • 23 Valentin A, Subramanian S, Quan SF, Berry RB, Parthasarathy S. Air leak is associated with poor adherence to autoPAP therapy. Sleep (Basel) 2011; 34 (06) 801-806
    CrossrefPubMedGoogle Scholar