According to research presented at the 20th Anniversary Meeting of  the American Academy of Dental Sleep Medicine (AADSM), the  apnea-hypopnea index (AHI) in patients with severe obstructive sleep  apnea (OSA) was more improved by a combination treatment of a mandibular  advancement splint (MAS) and positive airway pressure (PAP) therapy  than by continuous positive airway pressure (CPAP) therapy alone.

Results show that without lowering the pressure substantially, CPAP  tolerance can be improved and severe OSA can be effectively treated  using a MAS that physically supports and stabilizes the position of  nasal pillows (TAP-PAP).

The study involved data from 10 male and female patients who were  first treated for severe obstructive sleep apnea (OSA). Polysomnogram (PSG) data were obtained  from patients’ initial diagnostic CPAP titration, and combined MAS-PAP  titration studies. The seven patients who completed the study had a mean  AHI of 66 breathing pauses per hour of sleep prior to treatment, 4.4  events per hour with CPAP therapy alone, and 2.6 events per hour with  combined MAS-PAP. Epworth Sleepiness Scale (ESS) scores were also  obtained to measure excessive daytime sleepiness. ESS scores decreased  from 10.1 to 7.9 to 4.9, respectively.

“The primary finding of the study is that patients with severe OSA  who were noncompliant with CPAP and suffered from effects of nightly  hypoxia and poor quality of sleep are now compliant with MAS-PAP,” said  lead investigator John White, DDS, D. ABDSM.

Home sleep tests (Watch-Pat) were obtained prior to MAS delivery,  after MAS titration, and with combined MAS-PAP. The patients’ mean AHI  was 54.4 events per hour before MAS delivery, 40.2 events per hour using  MAS alone, and 10 events per hour with combination therapy. The amount  of sleep time during which oxygen saturation was less than 90% decreased  from 20.8% to 11.5% to 3%, respectively.

Patients reported reasons for intolerance using a 13-item checklist.  With traditional CPAP therapy, each patient reported two to six reasons  for intolerance. Most commonly reported reasons were: “can’t keep in  place” (85.7%), “unconsciously remove” (57.1%); “mask uncomfortable,”  “mask leaks,” and “claustrophobia” (42.9% each). With combination  therapy, only two patients reported a single negative experience:  “unconsciously remove,” “pull of hose applies force to teeth.”

“These results are important because a patient with severe obstructive sleep apnea (OSA) who is  unable to comply with CPAP has no other viable treatment options,” said  White. “This therapy offers patients a significant improvement in  quality of sleep, which leads to improved moods, performance, and  overall outlook on life.”

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