Oral appliance in sleep apnea treatment: respiratory and clinical effects and long-term adherence.

Abstract

There is an increasing tendency to use oral appliance (OA) as an alternative treatment for sleep apnea. Here we report the long-term adherence and clinical effects of OA therapy. All sleep apnea patients treated at the Department of Dentistry between the years 2006 and 2013 (n = 1208) were reviewed. A questionnaire about OA adherence, asthma symptoms (Asthma Control Test™, ACT), and general health was sent to all patients who continued OA therapy after the 1-month follow-up visit (n = 811). OA was adjusted to obtain at least 70% of the maximal protrusion of the mandible. The response rate was 37.4% (99 women, 204 men). The mean ± SD age and BMI were 58.7 ± 10.3years and 27.3 ± 4.0kg/m(2), respectively. During the mean follow-up period of 3.3years, there was no significant variation in BMI. Forty-one patients abandoned OA therapy yielding an adherence rate of 86%. Ninety-seven percent of patients used OA ≥4h/day, and the mean daily use was 7.2 ± 1.1h. The ACT score improved with OA use from 16.0 ± 5.9 to 20.1 ± 3.8 (p = 0.004), indicating better asthma control. The apnea and hypopnea index decreased significantly from 27 ± 19 at baseline to 10 ± 10 with OA therapy (p = 0.001). After a 1-month trial period, the long-term adherence to oral appliance was good. OA therapy decreased apneas and hypopneas significantly, and its long-term use was associated with an improvement in respiratory and asthma symptoms.