Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

Thyagaseely Sheela Premaraj; Jacob Stadiem; Shyamaly Arya Premaraj; Charles R. Davies; Matthew Dennis; John J. Harrington

doi:10.1055/s-0040-1719220

European Journal of Dentistry, Table of Contents

CC BY 4.0 · Eur J Dent 2022; 16(04): 749-755
DOI: 10.1055/s-0040-1719220

Original Article

Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

Thyagaseely Sheela Premaraj

¹Department of Orthodontics, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, United States

,

Jacob Stadiem

²Department of Orthodontics, University of Nebraska Medical Center, Lincoln, Nebraska, United States

,

Shyamaly Arya Premaraj

³College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, United States

,

Charles R. Davies

⁴Carle Neuroscience Institute, Carle Physician Group, University of Illinois at Urbana, Illinois, United States

,

Matthew Dennis

⁵Division of Pediatric Pulmonology & Sleep Medicine, University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha, Nebraska, United States

,

John J. Harrington

⁶Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States

› Author Affiliations

Abstract

Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks.

Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study.

Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance.

Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference.

Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

Keywords

auto-adjusting positive airway pressure - Epworth Sleepiness Scale scores - mandibular advancement device - obstructive sleep apnea

Full Text

References

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