Abstract
Study Objectives: In patients with severe obstructive sleep apnea syndrome (OSAS), continuous positive airway pressure (CPAP) is first-line therapy. Compliance to CPAP is sometimes a problem, and mandibular advancement device (MAD) is then an alternative. However, this alternative is often not effective. It was hypothesized that patients suffering from OSAS would have a freer airway, resulting in a decreased apnea-hypopnea index (AHI), through use of a cervical collar (CC) to extend the neck. To study the effect of this new therapy, a randomized crossover study was conducted to compare MAD monotherapy with CC/MAD combination therapy. Methods: Eight patients with severe OSAS (AHI>30) who had ceased to use CPAP were enrolled in the randomized crossover study. Four patients started with MAD and four with CC/MAD for one week followed by a wash-out period and then cross-over. Polygraphic sleep recordings were performed at baseline and after each therapy. Results: The baseline AHI was 51.5 ± 22.5. AHI was reduced to 30.4 ± 23.2 through MAD monotherapy, and to 14.9 ± 10.2 through CC/MAD combination therapy. The effect of the combination therapy was statistically significantly (p=0.018) better than that of the monotherapy. Four patients were achieved an AHI<10/h through use of the combination therapy. Concusions: The study showed a significant reduction in AHI scores in patients with severe OSAS through use of the CC/MAD combination therapy as compared to the MAD monotherapy. This first report indicates a new possibility for treating severe OSAS in non-compliant CPAP users.
Highlights
Obstructive sleep apnea syndrome (OSAS) is a common disease in the adult population [1]
apnea-hypopnea index (AHI) was reduced to 30.4 ± 23.2 through mandibular advancement device (MAD) monotherapy, and to 14.9 ± 10.2 through cervical collar (CC)/MAD combination therapy
Concusions: The study showed a significant reduction in AHI scores in patients with severe OSAS through use of the CC/MAD combination therapy as compared to the MAD monotherapy
Summary
Obstructive sleep apnea syndrome (OSAS) is a common disease in the adult population [1]. CPAP is the most effective treatment for patients with severe OSAS; 29%-83% of patients use CPAP for less than 4 hours a night due to the practical difficulties of using the CPAP device [7]. Among 80 patients who participated in their study, 15% had abandoned CPAP after 10 months, and 31% never commenced therapy after the initial diagnosis [8]. Oral therapy such as use of a mandibular advancement device (MAD) has been shown to be an effective treatment for mild to moderate OSAS [9,10,11]. MAD therapy is an alternative when patients reject CPAP or when CPAP is not tolerated for various reasons [12]; the effect is less powerful than that achieved with CPAP [13]
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