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Lei H, Wang Z, Yang Y, Chen M. The development of a novel bidirectional fine-tuning mandibular advancement device. BMC Oral Health 2024; 24:846. [PMID: 39060977 PMCID: PMC11282822 DOI: 10.1186/s12903-024-04619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE To develop a novel mandibular advancement device (MAD) with high comfort, good compliance, and bidirectional fine-tuning capability for patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and to evaluate the therapeutic efficacy of the new MAD. METHODS The MAD, featuring upper and lower dental splints with a fine-tuning mechanism for mandibular adjustment, incorporates improved design elements such as partial dental coverage, shortened baffles, and memory resin lining. The novel MAD was used to treat 30 OSAHS patients in the study, comparing pre- and post-treatment scores on the Epworth Sleepiness Scale (ESS), the Apnea-Hypopnea Index (AHI), and the lowest oxygen saturation (LSO2). RESULTS The novel MAD reduced size and side effects, enhancing comfort. All patients complied well, using it for an average of 95% over 30 days and ≥ 5 h nightly. After treatment, significant improvements were observed in ESS, AHI, and LSO2 (P < 0.05). CONCLUSIONS This novel bidirectional adjustable MAD provides high comfort and compliance, improving treatment precision. It is an effective choice for mild to moderate OSAHS patients and an alternative for those intolerant to CPAP or averse to surgery.
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Affiliation(s)
- Huijia Lei
- Department of Otorhinolaryngology, Beijing Jishuitan Hospital, Capital Medical University, NO.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, P. R. China.
| | - Zijing Wang
- Department of Otorhinolaryngology, Beijing Jishuitan Hospital, Capital Medical University, NO.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, P. R. China
| | - Yang Yang
- Department of Otorhinolaryngology, Beijing Jishuitan Hospital, Capital Medical University, NO.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, P. R. China
| | - Mo Chen
- Department of Otorhinolaryngology, Beijing Jishuitan Hospital, Capital Medical University, NO.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, P. R. China
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Sériès F, Lacasse Y, Lajoie A. Identification of quality-of-life clusters by the Quebec sleep questionnaire in sleep apnea patients. J Sleep Res 2024:e14239. [PMID: 38811859 DOI: 10.1111/jsr.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/31/2024]
Abstract
Patients with obstructive sleep apnea (OSA) may present different symptoms. The clinical importance of symptom clustering is supported by the difference in the incidence of cardiovascular diseases between hypersomnolent and non-hypersomnolent sleep apnea patients. The objective of this study was to determine if quality-of-life clusters could be identified from the Quebec Sleep Questionnaire (QSQ) in OSA patients. Latent class analysis was used to identify clusters in a multivariate analysis of dichotomic variables (presence or absence of symptoms) for each item the QSQ obtained from 147 patients who fulfilled the questionnaire during its validation and subsequent trials (75.5% males, age: 53 ± 11 years, body mass index (BMI): 30.4 ± 4.7 kg/m2, apnea/hypopnea index (AHI): 31.3 ± 14.8/h). Three clusters were identified. Quality of life was preserved in patients of cluster 1 (20.4% of patients). Patients of cluster 2 (32.6% of patients) had a moderately impaired quality of life, mainly due to daytime somnolence and poor sleep quality. Patients with impaired quality of life (cluster 3, 46.9% of patients) had an important impact in every domain of the QSQ with the highest sleepiness and daytime symptom impairments. Gender, BMI, and AHI did not differ between the three clusters. In conclusion, different quality-of-life clusters can be identified from the QSQ in sleep apnea patients. These clusters are similar to those reported previously. Further studies are needed to validate these clusters in larger and independent cohorts, to evaluate how they respond to OSA treatment, and their relationship with incident outcomes.
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Affiliation(s)
- Frédéric Sériès
- Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ-UL), Quebec City, Quebec, Canada
- Multidisciplinary Department of Respiratory Medicine and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada
| | - Yves Lacasse
- Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ-UL), Quebec City, Quebec, Canada
- Multidisciplinary Department of Respiratory Medicine and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada
| | - Annie Lajoie
- Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ-UL), Quebec City, Quebec, Canada
- Multidisciplinary Department of Respiratory Medicine and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada
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3
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Buiret G, Molta CT. Does oral appliance efficacy in treating obstructive sleep apnea depend on the appliance specialist's experience? Sleep Breath 2024; 28:555-560. [PMID: 37676348 DOI: 10.1007/s11325-023-02908-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE In France, oral appliances (OAs) are the first-line treatment for moderate and second-line treatment for severe obstructive sleep apnea-hypopnea syndrome. In general, the sleep specialist refers his/her patient to the appliance specialist for the impressions and the fitting. However, is there a relationship between the volume of activity of the appliance specialist and the efficacy of this device? METHODS Our unit includes seven appliance otolaryngology specialists whose activities are highly variable (number of patients varying by a factor of almost 10). Data from a prospective follow-up registry of patients treated with an OA for moderate and severe obstructive sleep apnea-hypopnea syndrome were studied, and differences in outcomes between practitioners in the team were sought. RESULTS Among 859 patients, OAs significantly reduced the apnea-hypopnea index. Even if the patients were not completely comparable from one practitioner to another, there was a significant heterogeneity in efficacy (complete or partial response of the apnea-hypopnea index and failure of OAs) between practitioners (p = 0.0038; 0.0011; 0.0007 respectively), with better results in practitioners with a higher level of OA activity. CONCLUSION The findings suggest that it may be preferable to refer patients to OA practitioners who see a higher volume of patients with moderate or severe obstructive sleep apnea-hypopnea syndrome treated with an OA.
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Affiliation(s)
- G Buiret
- Service ORL, Centre Hospitalier de Valence, 179 Boulevard du Maréchal Juin, 26953, Valence, cedex, France.
| | - C T Molta
- Service ORL, Centre Hospitalier de Valence, 179 Boulevard du Maréchal Juin, 26953, Valence, cedex, France
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Cebola P, Caroça C, Donato H, Campos A, Dias SS, Paço J, Manso C. Computed Tomography versus Sleep Endoscopy (DISE) to Predict the Effectiveness of Mandibular Advancement Devices in Adult Patients with Obstructive Sleep Apnea: A Protocol for Systematic Review. J Clin Med 2023; 12:6328. [PMID: 37834971 PMCID: PMC10573249 DOI: 10.3390/jcm12196328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Obstructive sleep apnea is a sleep disorder with a high prevalence in the world population. The mandibular advancement device is one of the options for treating obstructive sleep apnea. Neck computed tomography and drug-induced sleep endoscopy are complementary diagnostic tests that may help predict the effectiveness of mandibular advancement devices. This study aims to analyze the best method for predicting the effectiveness of mandibular advancement devices in the therapeutic approach to obstructive sleep apnea. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection databases will be comprehensively searched. We will include randomized clinical trials, non-randomized prospective or retrospective clinical studies, case controls, cohort studies, and case series. Two authors will independently conduct data extraction and assess the literature quality of the studies. The analysis of the included literature will be conducted by Revman 5.3 software. The outcomes that will be analyzed are craniofacial characteristics, cephalometric assessments, site and type of obstruction of the upper airway, mean values of the apnea-hypopnea index, and SaO2 verified in the initial and follow-up polysomnography. This study will provide reliable, evidence-based support for the clinical application of mandibular advancement devices for obstructive sleep apnea.
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Affiliation(s)
- Pedro Cebola
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (P.C.); (C.M.)
- CUF Tejo Hospital, 1300-352 Lisboa, Portugal; (A.C.); (J.P.)
| | - Cristina Caroça
- CUF Tejo Hospital, 1300-352 Lisboa, Portugal; (A.C.); (J.P.)
- CHRC, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1169-056 Lisboa, Portugal
| | - Helena Donato
- Documentation and Scientific Information Service, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Ana Campos
- CUF Tejo Hospital, 1300-352 Lisboa, Portugal; (A.C.); (J.P.)
| | - Sara Simões Dias
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC) da NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), CEDOC—Campus Sant’Ana, Pólo de Investigação, NMS, UNL, Edifício Amarelo, Rua do Instituto Bacteriológico no. 5, 1150-082 Lisboa, Portugal;
- EpiSaúde Sociedade Científica, 7005-837 Évora, Portugal
- Escola Superior de Saúde do Instituto Politécnico de Leiria, Unidade de Investigação em Saúde (UI), 2411-901 Leiria, Portugal
| | - João Paço
- CUF Tejo Hospital, 1300-352 Lisboa, Portugal; (A.C.); (J.P.)
- CHRC, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), 1169-056 Lisboa, Portugal
| | - Cristina Manso
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Almada, Portugal; (P.C.); (C.M.)
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Les orthèses d’avancées mandibulaires chez les patients souffrant d’un SAHOS sévère. Éfficacité à court et long terme, facteurs prédictifs d’efficacité. Rev Mal Respir 2022; 39:321-327. [DOI: 10.1016/j.rmr.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/26/2021] [Indexed: 11/17/2022]
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6
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[Mandibular advancement device and multidisciplinary consultation of sleep-disorders]. Rev Mal Respir 2021; 38:807-815. [PMID: 34454816 DOI: 10.1016/j.rmr.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multidisciplinary consultation of sleep-disorders can include recommendation of a mandibular advancement device (MAD) for some patients with obstructive sleep apnea syndrome (OSAS). AIM To assess the outcomes of patients for whom an oral MAD was prescribed following multidisciplinary consultation for OSAS in a University Hospital Center. METHODS All patients referred by hospital or community specialist who had visited this specialized service from December 2015 to December 2017 and to whom an MAD was prescribed were included in this study. The objective was to analyze their clinical course after this consultation and to assess the effectiveness of these devices in this population. RESULTS In all, 184 patients were seen by the multidisciplinary consultation between December 2015 and December 2017. An MAD was offered to 148 patients and 70 of these went on to have one. Of these 52 of them received follow-up polygraphy (PG) with it in place. This confirmed effectiveness in 18 cases (decrease of at least 50% of the AHI. The average AHI went from 34.8/hr to 22.5/hr. Sixty-five of the 148 patients were lost to follow-up. CONCLUSION After specialized consultation on sleep-disorders, only one-third of the patients to whom an OA was prescribed had polygraphic exam. OA was less effective than in equivalent series. Correctives measures (such as a multidisciplinary standard sheet) have been set up to ensure a close follow-up of patients.
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Vecchierini MF, Attali V, Collet JM, d'Ortho MP, Goutorbe F, Kerbrat JB, Leger D, Lavergne F, Monaca C, Monteyrol PJ, Mullens E, Pigearias B, Martin F, Khemliche H, Lerousseau L, Meurice JC. Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data. J Clin Sleep Med 2021; 17:1695-1705. [PMID: 34165074 DOI: 10.5664/jcsm.9308] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVES Mandibular advancement devices (MADs) are an alternative to continuous positive airway pressure for the management of obstructive sleep apnea (OSA). The ORthèse d'avanCée mAndibulaire dans le traitement en DEuxième intention du SAHOS sévère (ORCADES) study is investigating the long-term effectiveness of MAD therapy in patients with OSA who refused or were intolerant of continuous positive airway pressure. Five-year follow-up data are presented. METHODS Data were available in 172 of 331 patients treated with a custom-made computer-aided design/computer-aided manufacturing biblock MAD (Narval CC; ResMed, Saint-Priest, France). The primary end point was treatment success (≥50% decrease in apnea-hypopnea index from baseline). RESULTS Five-year treatment success rates were 52% overall and 25%, 52%, and 63%, respectively, in patients with mild, moderate, or severe OSA. This reflects a decline over time vs 3-6 months (79% overall) and 2 years (68%). Rates declined in all patient subgroups but to the greatest extent in patients with mild OSA. The slight worsening of respiratory parameters over time was not associated with any relevant changes in sleepiness and symptoms. Moderate or severe OSA at baseline, treatment success at 3-6 months, and no previous continuous positive airway pressure use were significant independent predictors of 5-year treatment success on multivariate analysis. No new safety signals emerged during long-term follow-up. The proportion of patients using their MAD for ≥4 h/night on ≥4 days/wk was 93.3%; 91.3% of patients reported device use of ≥6 h/night at 5 years. At 5-year follow-up, 96.5% of patients reported that they wanted to continue MAD therapy. CONCLUSIONS Long-term MAD therapy remained effective after 5 years in >50% of patients, with good levels of patient satisfaction and adherence. CITATION Vecchierini MF, Attali V, Collet JM, et al. Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data. J Clin Sleep Med. 2021;17(8):1695-1705.
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Affiliation(s)
- Marie-Françoise Vecchierini
- AP-HP, Hôpital Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Valérie Attali
- AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Jean-Marc Collet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-Faciale, Paris, France
| | - Marie-Pia d'Ortho
- Physiologie Clinique- Explorations Fonctionnelles et Centre du Sommeil, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, INSERM, UMR 1141 NeuroDiderot, Paris, France
| | - Frederic Goutorbe
- Centre Médecine du Sommeil, Centre Hospitalier de Béziers, Béziers, France
| | - Jean-Baptiste Kerbrat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-Faciale, Paris, France.,Hôpital Charles Nicolle, Stomatologie et Chirurgie Maxillo-Faciale, Rouen, France
| | - Damien Leger
- AP-HP, Hôpital Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | | | | | - Eric Mullens
- Fondation Bon Sauveur, Laboratoire du Sommeil, Albi, France
| | | | - Francis Martin
- AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
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Stern J, Lee K, Kuhns D, Martinez-Kratz JF. Efficacy and Effectiveness of the ProSomnus® [IA] Sleep Device for the Treatment of Obstructive Sleep Apnea: EFFECTS Study. Cureus 2021; 13:e15391. [PMID: 34249542 PMCID: PMC8252976 DOI: 10.7759/cureus.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives To evaluate the effectiveness of a new mandibular advancement device (MAD) (Prosomnus® [IA] Sleep Device, Prosomnus Sleep Technologies, Pleasanton CA) fitted with a compliance tracker as a first-line treatment in a population of patients with mild to severe obstructive sleep apnea (OSA). Methods Treatment effectiveness was measured using pre and post-treatment home sleep testing (HST) and validated sleep and quality of life questionnaires. Mean disease alleviation (MDA) was calculated to compare the treatment effectiveness of MAD to historical continuous positive airway pressure (CPAP) effectiveness data. Results MAD was found to be an effective first-line treatment for patients with mild, moderate, and severe sleep apnea with excellent compliance rates, similar to or better than CPAP, and an equal or better MDA of 56.7% compared to literature values of 50% for CPAP. Conclusions MAD should be considered an effective first-line treatment for patients with mild and moderate sleep apnea and for severe sleep apnea for patients who prefer, refuse, or are not candidates for CPAP.
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Affiliation(s)
- Jordan Stern
- Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, USA
- Sleep Medicine, BlueSleep, New York, USA
| | | | - Dave Kuhns
- Sleep Apnea, ProSomnus Sleep Technologies, Pleasanton, USA
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Trzepizur W, Adrian B, Le Vaillant M, Meslier N, Kün-Darbois JD, Gagnadoux F. Predicting treatment response to mandibular advancement therapy using a titratable thermoplastic device. Clin Oral Investig 2021; 25:5553-5561. [PMID: 33650081 DOI: 10.1007/s00784-021-03865-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/25/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. We describe the use of a trial of a titratable thermoplastic MAD to predict treatment outcomes with a custom-made MAD. MATERIALS AND METHODS Patients treated with a thermoplastic MAD as a trial before custom-made MAD manufacturing were included in the study. Sleep recordings and clinical outcomes assessed after 6 months of treatment with each device were compared. Predictive utility of thermoplastic MAD to identify custom-made MAD treatment success defined as a reduction greater than 50% and final apnea-hypopnea index (AHI) less than 10 events/h was evaluated. RESULTS Thermoplastic MADs were installed in 111 patients, but only 36 patients were finally treated with both devices and were included in the analysis. A significant correlation was observed between the impact of the two devices on the AHI (r=0.85, p<0.0001), oxygen desaturation index (r=0.73, p<0.0001), snoring index (r=0.85, p<0.0001), and Epworth sleepiness scale (r=0.77, p<0.0001). A high positive predictive value (86%) but a low negative predictive value (46%) was observed regarding AHI decrease. CONCLUSIONS Similar impacts of both MADs were observed on major OSA severity markers and symptoms. The ability of thermoplastic MAD to indicate likelihood of success with custom-made MAD will require further controlled studies. CLINICAL RELEVANCE Thermoplastic MADs could represent a useful and easily implemented tool to predict the likelihood of success of a custom-made MAD as treatment for OSA.
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Affiliation(s)
- Wojciech Trzepizur
- INSERM U1063, SOPAM, Angers University, F-49045, Angers, France. .,Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France. .,Département de Pneumologie, CHU, 4 rue Larrey, 49100, Angers, France.
| | - Benjamin Adrian
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
| | - Marc Le Vaillant
- Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | - Nicole Meslier
- INSERM U1063, SOPAM, Angers University, F-49045, Angers, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
| | | | - Frédéric Gagnadoux
- INSERM U1063, SOPAM, Angers University, F-49045, Angers, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
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Abstract
Long-term effective therapy is essential for obstructive sleep apnea (OSA) control and preventing comorbidity. OSA patients are often reported to be more receptive to oral appliance therapy over positive airway pressure (PAP). Oral appliance usage can now be objectively recorded by temperature microsensors. Studies using commercially available microsensor chips have reported data out to 1 year, with high rates of adherence (>80%), albeit in small samples. There is opportunity to further use this technology to understand individual adherence factors and patterns and in obtaining objective measures of treatment effectiveness, particularly for longer-term health outcomes and allowing comparison to PAP.
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