Visscher, L. (Lonneke) (2013) De effectiviteit van MRA en CPAP bij Obstructief Slaap Apneu Syndroom, gebruikt volgens de CBO richtlijn. thesis, Medicine.
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Abstract
Background: In Obstructive Sleep apnoea Syndrome (OSAS) repetitive upper airway collapse causes cessation of breathing and periods of respiratory depression during sleep. This leads to excessive daytime sleepiness, increased morbidity and mortality. Continuous positive airway pressure (CPAP) is considered as the reference treatment for OSAS. Positive airway pressure keeps the upper airway from collapsing. A Mandibular Repositioning Appliance (MRA), keeps the airway open through forward reposition of the lower jaw. The CBO guideline of 2009 states that, in selected cases, CPAP and MRA have the same efficacy in moderate OSAS. This has never been tested clinical practise. Methods: This study is an retrospective observational inventory of treatments and cardiovascular risk, in a population diagnosed with OSAS in the Medisch Spectrum Twente in 2011. Specific the treatment results of CPAP and MRA for moderate OSAS (AHI15-30 or moderate symptoms) will be tested. Due to the retrospective order of the study and the different patient characteristics, results are corrected with a propensity score. Non-inferiority was defined 25% and has an odds ratio of 3.27. This is the maximum top end of the 95% confidence interval. The 10-year risk of cardiovascular disease of the treated OSAS population is calculated using the Framingham model. Statistical analyzes are preformed with SPSS 20. Results: In 2011 75 MRA and 256 CPAP treatments where started in the MST, of which 31 and 123 in moderate OSAS. The 95% confidence interval for the corrected OSAS population lies between 0.347 and 2.044. The confidence interval for the corrected results of moderate OSAS, lies between 0.137 and 1.45. Both stay below 3.27, and with the given criteria non-inferiority can be accepted. The mean risk of cardiovascular disease in this population is 16.5%. The risk in the group treated with CPAP(18.3%) differs (p0.000) from the group treated with MRA(16.5%). Conclusion: If the choice of therapy occurs as stated in the CBO guideline of 2009, treatment with MRA is not inferior to treatment with CPAP. In particular for moderate OSAS. Using the Framingham model, the calculated 10 year risk of cardiovascular disease is elevated in this OSAS population treated with CPAP or MRA.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Eijsvogel, Drs. M.M.M. and Medisch Spectrum Twente |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:56 |
| Last Modified: | 25 Jun 2020 10:56 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1709 |
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