Sleep Disorders |

Does Therapeutic Continuous Positive Airway Pressure Predict Success With an Oral Appliance in the Treatment of Obstructive Sleep Apnea FREE TO VIEW

John Park, MD; Julie Williams, PA-C; Julie Johnson, RN; Kevin Reid, DMD; Kannan Ramar, MD
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Mayo Clinic, Rochester, MN

Chest. 2013;144(4_MeetingAbstracts):978A. doi:10.1378/chest.1705070
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM

PURPOSE: While continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA), compliance remains suboptimal. Oral appliance (OA) is an acceptable alternate to CPAP in those with mild OSA (apnea-hypopnea index [AHI] < 15/hr of sleep). Pressure requirement from CPAP is usually lower in mild OSA. Rather than OSA severity, we therefore, hypothesized that lower therapeutic CPAP requirement would better predict favorable response to OA.

METHODS: We retrospectively collected data on all subjects who underwent a diagnostic and therapeutic polysomnogram (PSG), subsequent oral appliance therapy, and a follow up PSG or an overnight oximetry between 2006 and 2011. Residual AHI or oxygen desaturation index (ODI) was used to assess response to therapy.

RESULTS: Of the 123 subjects with an average age of 55.3 ± 12.2 years, 60 were male. Average body mass index was 29.5 ± 5.4 kg/m2 with an average neck circumference of 38.8 ± 3.7 cm. Eighty subjects (65%) who required CPAP ≤ 7 cm H2O had resultant AHI/ODI of 4.7 ± 6.6 with their OA, whereas the remaining who required pressures > 7 cm H2O had resultant AHI/ODI of 7.4 ± 6.6. Among those who required CPAP ≤ 7 cm H2O, 30% of the subjects had baseline AHI > 15. Of these 24, 54% had resultant AHI/ODI < 5 while 79% had resultant AHI/ODI < 10 on the OA. Eighty-two subjects who had baseline AHI <15 had resultant AHI/ODI of 4.5 ± 4.7. Of these 82 subjects, 72% had residual AHI/ODI < 5. Subjects with baseline AHI < 15 and final CPAP of ≤ 7 cm H2O, had residual AHI/ODI of 3.63 ± 3.5. Eighty-two percent in this group had resultant AHI/ODI < 5.

CONCLUSIONS: Therapeutic CPAP requirement ≤ 7 cm H2O to treat OSA seems to have some predictive value in determining OA success. Therapeutic pressure combined with baseline AHI < 15 seem to better predict OA success than either pressure requirement or baseline AHI.

CLINICAL IMPLICATIONS: Combination of factors seem to better predict success of OA in treatment of OSA.

DISCLOSURE: The following authors have nothing to disclose: John Park, Julie Williams, Julie Johnson, Kevin Reid, Kannan Ramar

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