Long-term effectiveness of Oral Appliance versus Continuous Positive Airway Pressure in the treatment of Obstructive Sleep Apnea Syndrome: Nine-year follow-up.

Sokolova, D.S. (Dilyana) (2015) Long-term effectiveness of Oral Appliance versus Continuous Positive Airway Pressure in the treatment of Obstructive Sleep Apnea Syndrome: Nine-year follow-up. thesis, Dentistry.

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Abstract

Background: Most patients with obstructive sleep apnea syndrome (OSAS) are treated with either an Oral Appliance (OA) or Continuous Positive Airway Pressure (CPAP) therapy. Both therapies are non-invasive and life-long therapies. Objective: The purpose of the presented study was to gain more insights into the effectiveness of OA and CPAP therapy in the long term. Design: Cohort study of a previously conducted randomized clinical trial (RCT). This trail included two intervention groups, assigned by randomisation. The first group consisted of 51 patients that received OA as a therapy , while the second group consisted of 52 patients who were treated with CPAP. In the previous RCT, the patients were already evaluated at baseline, two months, one year and two years. The present study concerns the nine-year follow-up. Methods: The nine-year follow-up was successfully completed by 14 patients in the OA group and 17 patients in the CPAP group. Data from objective (polysomnography) and subjective (standardised questionnaires and self-reported treatment satisfaction and compliance) measurements were obtained and compared with the data collected during the previous RCT. Therapy was considered successful when the apnoea-hypopnoea index (AHI) was < 5 of showed substantial reduction, defined as reduction in the index of at least 50% from the baseline value to a value of < 20 in a patient without OSAS symptoms. Results: The therapy was regarded as successful in the OA and CPAP group for the majority of the patients t (12 out of 14 patients in the OA group and 16 out of 17 patients in the CPAP group) that completed the nine-year follow-up. In both groups an increase in the mean AHI was noticed at nine year follow-up . This increase was higher in the OA group. However, the composition of the OA and CPAP group at the time of the nine-year follow-up was substantially different which made comparison between the groups impossible. There were significant improvements in the Epworth Sleepiness Scale, most domains of the Functional Outcomes of Sleep Questionnaire (FOSQ) and some domains of the Medical outcome Study 36-item Short Form Health Survey (RAND36), when comparing the baseline data with the nine-year follow-up data in both groups. Only the FOSQ domain ‘intimate relationship and sexual activity’ showed worsening in the CPAP group and no significant difference in the OA group. When evaluating individual patient data , the objective and subjective parameters did not always correlate. Conclusions: After nine years of therapy, therapeutic effect was still regarded as successful in the majority of OA and CPAP patient that were evaluated in this study. Due to the heterogeneity of the two groups at the nine-year follow-up, statistical comparison between the CPAP and MRA was not possible. Moreover, objective and subjective parameters did not always correlate at the nine-year follow-up indicating polysomnographic evaluation should be standardised in the long-term follow-up of OA and CPAP therapy.

Item Type:	Thesis (Thesis)
Supervisor name:	Hoekema, Dr. A. and Doff, Dr. Ing. M.H.J.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:58
Last Modified:	25 Jun 2020 10:58
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1851

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