Patient specific factors predicting adherence and treatment effect of oral appliance therapy in obstructive sleep apnea

Abstract

The overall objective of this thesis was to generate new knowledge about treatment with mandibular advancement devices (MAD). MAD. Adherence and MAD treatment effects were measured in patients suffering from obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) is the first-line treatment for OSA, and only patients who were non-adherent to CPAP were included in this project. The first study assessed the effect of MAD on the apnea/hypopnea index (AHI) of an individually adjusted MAD in patients with moderate(n=82) and severe (n=34) OSA.. Nocturnal respiratory polygraphic recordings (PG) were performed at baseline and 12- month follow-up, and reduction in AHI was the primary outcome for success. The overall treatment success rate was 75%, and there was no significant difference in success rates between the moderate and severe categories. Low pre-treatment oxygen saturation (SpO2 nadir) predicted MAD failure in the multiple regression analysis. The aim of the second study was to test whether a built-in MAD sensor was reliable compared to self-reported MAD use for one month. Patients (n=80) with all grades of OSA were included. The relative reliability was high with an intraclass coefficient (ICC) at r= 0.847. The aim of the third study was to measure AHI change, MAD adherence in patients with all grades of OSA, and to identify partner-specific factors related to adherence. The mean AHI was reduced to half at 8 month follow-up, and sensor-measured adherence rate at follow-up was 60.1%. Mean reduction in AHI was significantly greater in the “good” than in the “poor” adherence group. From the partner perspective, good adherence to MAD was associated with signifigreater positive effects on their relationship and being able to share bedroom again. We conclude that MAD seems to be an effective treatment alternative for all grades of OSA. Low SpO2nadir predicted a poor effect from MAD. Adherence to MAD could be reliably measured with a built-in sensor. MAD adherence is related both to the treatment effect and bedpartners’ motivational influence. Their attitude and support may be a hidden resource for improving adherence to MAD in the treatment of OSA.