Partner perceptions are associated with objective sensor-measured adherence to oral appliance therapy in obstructive sleep apnea.

Abstract

The aims of the present prospective clinical study were to determine objective, sensor-measured adherence to a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify partner-specific adherence-related factors. A total of 77 eligible participants with mild, moderate, or severe OSA and who were non-adherent to continuous positive airway pressure (mean age 56.2years) participated in the study (32.5% women). The mean (range) observation time between MAD delivery and final follow-up was 8.3(3.4-16.5)months. The mean apnea-hypopnea index (AHI) was 26.6events/hr at baseline and 12.5events/hr at the 8-month follow-up (both p<0.001). The mean sensor-measured adherence at the 8-month follow-up was 60.1% for ≥4hr/night of appliance use for ≥5days/week. Average usage was 6.4hr/night, when worn. The mean reduction in the AHI was significantly greater in the "good adherence" (Δ17.4) than the "poor adherence" group (Δ11.0; p<0.05). From the partner's perspective, the appliance had a positive effect on sharing a bedroom in the good- (55%) compared to the poor-adherence group (25%; p<0.05) and on their relationship (51.7% versus 17.9%, respectively; p<0.05). Regression analyses identified the partner's snoring and apneas to be the most significant factor predicting good adherence to MAD (odds ratio 4.4, 95% confidence interval 1.4-14.0). In conclusion, social factors, like partner perceptions, were positively associated with adherence, which indicate that partner's attitudes and support may be a resource that can be utilised to improve adherence in oral appliance treatment of OSA.