Abstract
ObjectivesTo evaluate the effectiveness of a new mandibular advancement device (MAD) (Prosomnus® [IA] Sleep Device, Prosomnus Sleep Technologies, Pleasanton CA) fitted with a compliance tracker as a first-line treatment in a population of patients with mild to severe obstructive sleep apnea (OSA).MethodsTreatment effectiveness was measured using pre and post-treatment home sleep testing (HST) and validated sleep and quality of life questionnaires. Mean disease alleviation (MDA) was calculated to compare the treatment effectiveness of MAD to historical continuous positive airway pressure (CPAP) effectiveness data.ResultsMAD was found to be an effective first-line treatment for patients with mild, moderate, and severe sleep apnea with excellent compliance rates, similar to or better than CPAP, and an equal or better MDA of 56.7% compared to literature values of 50% for CPAP.ConclusionsMAD should be considered an effective first-line treatment for patients with mild and moderate sleep apnea and for severe sleep apnea for patients who prefer, refuse, or are not candidates for CPAP.
Highlights
Obstructive sleep apnea (OSA) is a common disorder that affects nearly 1 billion people globally [1]
mandibular advancement device (MAD) was found to be an effective first-line treatment for patients with mild, moderate, and severe sleep apnea with excellent compliance rates, similar to or better than continuous positive airway pressure (CPAP), and an equal or better Mean disease alleviation (MDA) of 56.7% compared to literature values of 50% for CPAP
The question is, whether this is sufficient to reduce the signs and symptoms associated with OSA? The SAVE study (Sleep Apnea cardioVascular Endpoints study) showed no significant reduction in cardiovascular events when patients were treated with CPAP; it was observed that the average CPAP use during the study was only 3.3 hrs/night [9]
Summary
Obstructive sleep apnea (OSA) is a common disorder that affects nearly 1 billion people globally [1]. Each treatment modality has variable proven success among patients, with varying levels of disease severity, the ratio of the prescribed treatments is nearly 10 to one in favor of CPAP over MAD and other non-CPAP treatments [3,4]. Patients using CPAP often struggle with adherence to the prescribed treatment, with compliance levels after one year ranging from 30%-60% depending on how compliance is defined [5,6,7,8]. Weaver demonstrated that the hours of CPAP use are correlated with outcomes [8]; Rotenberg concluded that CPAP adherence remains persistently low over 20 years of reported data and questions CPAP as the “standard” treatment for obstructive sleep apnea [5]
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