Continuous positive airway pressure (CPAP) is the treatment of choice for most patients with obstructive sleep apnea (OSA). Oral appliances (OA) are indicated as a treatment option for mild OSA, but are not typically used in patients with more severe disease due to a lack of perceived benefit and concerns for high failure rates. CPAP may hinder military service and patients with OSA are often referred for OA therapy regardless of disease severity. The purpose of this study was to determine the efficacy of OAs in ablating obstructive events in a wide spectrum of disease severity.
Retrospective review of consecutive adult patients diagnosed with OSA between 2000 and 2005 undergoing polysomnographic and OA titrations. We recorded demographic and polysomnographic data on all patients. The primary endpoint was the rate of successful OA titrations. Intolerance or a residual apnea-hypopnea index (AHI) > 5 was considered a treatment failure.
638 patients were included. 86.5 % were male. Mean age, AHI and BMI were 41.7±9.2, 30.2±24.9, and 28.7±4.5 respectively. Disease severity was stratified as mild (n=226), moderate (n=187) and severe (n=225). 162 (25.4%) of patients were intolerant to OA. Overall, OA were successful in 49.8% patients. OA were successful in 65.3% with mild, 49.6% with moderate and 35.1% with severe disease. 24.8% of patients had an unsuccessful titration. Patients with a BMI greater than 29.3 and a SpO2 below 90% for at least 7.8% of the night were less likely to normalize their AHI (p=0.004, p<0.001 respectively).
OA can be an effective treatment for OSA. While OA are more effective in patients with mild disease, those with moderate to severe disease may also benefit and should not be excluded from this therapeutic option.
OA may provide an alternate treatment option for military service members with OSA who are intolerant to CPAP or require therapy in an austere deployed setting.
Anita Shah, No Financial Disclosure Information; No Product/Research Disclosure Information