Adherence to oral appliance treatment and its determinants in obstructive sleep apnoea patients

ASSESSMENT BY ORAL HEALTH PROFESSIONALS OF PATIENT-REPORTED OUTCOMES IN OBSTRUCTIVE SLEEP APNEA

Oral health professionals, including general dentists and orthodontists, may participate in the provision of care to adults and children with obstructive sleep apnea (OSA) when referred by a sleep medicine specialist. The use of oral appliances (OA) has been presented as a possible management option for mild obstructive sleep apnea among adults. In children, although oral interventions are not supported as a first-line stand-alone management option for OSA, short-term studies have suggested an improvement in sleep signs and symptoms in milder cases. The monitoring of management outcomes from OA interventions is essential to monitor OSA conditions. Due to the chronic nature of OSA, the measure of dental patient-reported outcomes (dPROs) will likely help to understand interplaying factors that may influence the effectiveness of OA interventions among subjects with OSA. This narrative review discusses the current evidence regarding main dPROs in OSA, evaluation methods, and the contribution of oral health professionals in assessing it for both children and adults. The main dPROs assessed among OA users include quality of life, treatment adherence, and side effects. The use of validated tools to measure dPROs must be preferred when available. Overall, the clinical assessment of dPROs by oral health professionals is likely beneficial to monitoring OSA management outcomes and must be encouraged as part of an interdisciplinary approach led by the sleep physician.

Adherence to oral appliance treatment for obstructive sleep apnea in patients with continuous positive airway pressure failure

PURPOSE

The primary aim of this study was to determine the continuation and success rates of oral appliance (OA) therapy for patients in whom continuous positive airway pressure (CPAP) therapy failed. The secondary aim was to identify predictive factors for the long-term use of OA in patients with CPAP failure.

METHODS

A total of 81 patients who failed with CPAP use were included in this study. Patients who had been using OA for more than 1 year at follow-up visits were assigned to Group S, whereas those who discontinued OA or were lost to follow-up within 1 year were assigned to Group D. We investigated the continuation and success rates of OA therapy, as well as predictive factors for its long-term use for those with CPAP failure.

RESULTS

Of the 81 patients, 60 were in Group S and 21 were in Group D; 74.0% of patients with CPAP failure continued OA therapy for more than 1 year. The apnea-hypopnea index was reduced from 41.3±21.7/h to 12.4±6.5/h with OA therapy. The only significant predictor of long-term OA use in patients with CPAP failure was awareness of the effectiveness of OA therapy after 1 month (P = 0.003, odds ratio: 9.731, 95% confidence interval: 2.146-44.119).

CONCLUSIONS

Patients who recognized the effectiveness of OA treatment in the early stages were more likely to continue using OA therapy long-term.

Objectively measured adherence may affect side effects of mandibular advancement therapy in subjects with obstructive sleep apnea

PURPOSE

The purpose of this study was to determine if objectively measured adherence to oral appliance (OA) treatment may affect dental changes and temporomandibular disorders (TMD) in patients with obstructive sleep apnea (OSA).

METHODS

The original study group consisted of adults with OSA who were referred for OA therapy. Eight indicators of subjective side effects of using OA (temporomandibular joint (TMJ) and muscle pain, pain in teeth, jaw stiffness in the morning, clicking, dry mouth, hypersalivation, gingival irritation) were evaluated by a questionnaire. Three occlusal indicators (overjet, overbite, molar occlusion) and clinical TMD signs (TMJ pain, muscle pain, clicking, jaw deviation on opening) were evaluated at baseline and at the 3-, 6-, and 12-month follow-up. In addition, objective adherence monitoring for OA was registered. Statistical analyses included the chi-square test, Fisher's exact test, paired sample t-test, and linear regression analyses.

RESULTS

A total of 58 adults with OSA were referred for OA therapy. Mean (SD) age was 50.7 (11.7) and mean apnea-hypopnea index (AHI) was 19.5 (10.0). At 1-year follow-up, the study group consisted of 28 men and 12 women. Overjet but not overbite reduced significantly after 1-year OA therapy. The average nightly wear of OA was related to overjet and overbite reduction, and to TMD signs. Hypersalivation, dry mouth, and tooth discomfort were the most common subjective side effects of OA therapy.

CONCLUSION

There was a time-dependent relationship with the nightly wear of OA and reduction in overjet and overbite, and clinical TMD signs. With 60% of mandibular advancement, dental changes and TM-disorders were considered mild/minor in the 1-year study period.

Factors associated with treatment adherence to mandibular advancement devices: a scoping review

PURPOSE

Obstructive sleep apnea (OSA) is frequently treated with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs). For various reasons, both treatment options are often affected by low adherence. While factors associated with low CPAP adherence are described in the literature extensively, less is known about adherence to MAD therapy. This scoping review aimed to synthesize the body of literature on the factors associated with adherence to MAD treatment.

METHODS

A systematic literature search was conducted using bibliographic databases PubMed, Embase.com , Web of Science, and the Cochrane Library (Wiley) to identify relevant studies that described factors associated with adherence to MAD in the treatment of OSA or snoring combined with OSA in adults.

RESULTS

The literature search yielded a total of 694 references. Forty studies were found eligible for inclusion. The literature showed that factors with a possible negative influence on the adherence to MAD treatment are personality aspects; failing effectiveness of MAD; side effects during MAD therapy; using a thermoplastic MAD; dental treatments during MAD therapy; and a poor first experience with the MAD with inadequate guidance by professionals. Factors that may have a positive effect on MAD adherence include effectiveness of therapy, custom-made MAD, good communication skills of the practitioner, early recognition of side effects, stepwise titration of the MAD, and positive first experience with MAD.

CONCLUSIONS

The knowledge of factors associated with MAD adherence can be used to provide further insight into individual adherence to OSA treatments.

Effectiveness of remote monitoring and feedback on objective compliance with a mandibular advancement device for treatment of obstructive sleep apnea

Compliance with a mandibular advancement device is important for the optimal treatment of obstructive sleep apnea. Recent advances in information and communication technology-based monitoring and intervention for chronic diseases have enabled continuous monitoring and personalized management. Self-evaluation and self-regulation through objective monitoring and feedback may improve compliance. The aim of this study was to evaluate the effects of information and communication technology-based remote monitoring and feedback services, using a smartphone application, on the objective compliance with a mandibular advancement device in patients with obstructive sleep apnea. Forty individuals who were diagnosed with obstructive sleep apnea by polysomnography were randomly assigned to groups A and B. During an initial 6-week evaluation period, the mandibular advancement device-wearing time was monitored with the smartphone application in group B, but not in group A. The two groups then switched the monitoring procedures during the second 6-week period (the smartphone application was then used by group B, but not by group A). If no input data were indicated on the cloud server of the smartphone application during the monitored period, push notifications were provided twice daily. Objective compliance, monitored by a micro-recorder within the mandibular advancement device, was noted and compared based on whether the monitoring service was provided. The number of mandibular advancement device-wearing days was significantly higher in the monitored period than in the unmonitored period. The mandibular advancement device-wearing time did not differ significantly between the two groups. In conclusion, information and communication technology-based remote monitoring and feedback services demonstrated a potential to increase the objective measures of compliance with mandibular advancement devices.