Efficacy of An Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure For the Treatment of Obstructive Sleep Apnea Syndrome

Background: We sought to establish the efficacy of an adjustable oral appliance (aOA) in the largest patient population studied to date, and provide a comparison to CPAP.

Methods: Retrospective analysis of patients prescribed an aOA. Results of overnight, PSG with aOA titration were evaluated and compared to CPAP. Predictors of a successful aOA titration were determined using a multivariate logistic regression model.

Results: A total of 497 patients were prescribed an aOA during the specified time period. The aOA reduced the mean AHI to 8.4±11.4, and 70.3%, 47.6%, and 41.4% of patients with mild, moderate, and severe disease achieved an AHI<5, respectively. Patients using an aOA decreased their mean Epworth Sleepiness Score (ESS) by 2.71 (95% CI: 2.3-3.2; p<0.001) at follow-up. CPAP improved the AHI by - 3.43 (95% CI: 1.88-4.99; p<0.001) when compared to an aOA, but when adjusted for severity of disease, this difference only reached significance for patients with severe disease (-5.88 (95% CI: -8.95 - -2.82; p<0.001)). However, 70.1% of all patients achieved an AHI < 5using CPAP, compared to 51.6% for the aOA (p<0.001). On multivariate analysis, baseline AHI was a significant predictor of achieving an AHI < 5 on aOA titration, and age showed a trend toward significance.

Conclusions: In comparison to past reports, more patients in our study achieved an AHI < 5 using an aOA. The aOA is comparable to CPAP for patients with mild disease, while CPAP is superior for patients with moderate to severe disease. A lower AHI was the only predictor of a successful aOA titration.