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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
1   Department of Orthodontics, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, United States
,
Jacob Stadiem
2   Department of Orthodontics, University of Nebraska Medical Center, Lincoln, Nebraska, United States
,
Shyamaly Arya Premaraj
3   College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, United States
,
Charles R. Davies
4   Carle Neuroscience Institute, Carle Physician Group, University of Illinois at Urbana, Illinois, United States
,
Matthew Dennis
5   Division of Pediatric Pulmonology & Sleep Medicine, University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha, Nebraska, United States
,
John J. Harrington
6   Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
› Author Affiliations Funding This research was funded by DH Reinhardt Scholarship, College of Dentistry, University of Nebraska Medical Center. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
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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


Publication History

Article published online:
07 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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