Comparing efficacy of the mandibular advancement device after drug-induced sleep endoscopy and continuous positive airway pressure in patients with obstructive sleep apnea

Evgenia Sp Gogou; Vasileios Psarras; Nikolaos Nikitas Giannakopoulos; Aliki Minaritzoglou; Ioannis A Tsolakis; Vasileios Margaritis; Michail Ger Tzakis

doi:10.1007/s11325-023-02958-2

Comparing efficacy of the mandibular advancement device after drug-induced sleep endoscopy and continuous positive airway pressure in patients with obstructive sleep apnea

Sleep Breath. 2023 Dec 12. doi: 10.1007/s11325-023-02958-2. Online ahead of print.

Authors

Evgenia Sp Gogou¹, Vasileios Psarras², Nikolaos Nikitas Giannakopoulos^{3

4}, Aliki Minaritzoglou⁵, Ioannis A Tsolakis⁶, Vasileios Margaritis⁷, Michail Ger Tzakis²

Affiliations

¹ School of Dentistry, Orofacial Pain Clinic, National and Kapodistrian University of Athens, 11527, Athens, Greece. eugeniagogou@gmail.com.
² School of Dentistry, Orofacial Pain Clinic, National and Kapodistrian University of Athens, 11527, Athens, Greece.
³ Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527, Athens, Greece.
⁴ Department of Prosthodontics, University Clinic of Würzburg, Würzburg, Germany.
⁵ Center of Sleep Disorders, Department of Critical Care and Pulmonary Services, Medical School of National and Kapodistrian University of Athens, Evaggelismos Hospital, Athens, Greece.
⁶ Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
⁷ Research Center, Swiss School of Management, Bellinzona, Switzerland.

PMID: 38085497
DOI: 10.1007/s11325-023-02958-2

Abstract

Purpose: The purpose of this study was to compare objective and self-reported outcomes of two treatments for managing mild, moderate, and severe obstructive sleep apnea (OSA) in adults: a mandibular advancement device (MAD) and continuous positive airway pressure (CPAP).

Methods: Patients diagnosed with OSA by means of polysomnography (PSG) included one group treated with a custom-made, two-piece, adjustable MAD and a second group treated with CPAP for 8 weeks. Before the initiation of the treatment, all patients assigned to MAD underwent drug-induced sleep endoscopy (DISE), and all CPAP group patients underwent manual titration of CPAP after PSG. Objective (PSG) and self-reported (Epworth Sleepiness Scale [ESS] and Short Form Health Survey [SF-36]) data were used to assess outcomes. Collected data included apnea-hypopnea index (AHI), mean capillary oxygen saturation (SpO₂), oxygen desaturation index (ODI), arousal index (AI), degree of daytime sleepiness, and quality of life. A PSG follow-up after 8 weeks with MAD in situ, and data from the CPAP data card were used to assess the effect of the two treatments.

Results: A total of 59 patients included 30 treated with MAD and 29 treated with CPAP. Between baseline and the 8-week follow-up, the mean AHI score decreased significantly from 35.1 to 6.8 episodes/h (p < 0.001) in patients treated with MAD and from 35.2 to 3.0 episodes/h (p < 0.001) in patients treated with CPAP. The mean AHI score at the 8-week follow-up was significantly lower in CPAP group than in MAD group (p = 0.003). The two groups did not differ significantly at follow-up regarding SpO₂ (p = 0.571), ODI (p = 0.273), AI (p = 0.100), ESS score (p = 0.648), and SF-36 score (p = 0.237).

Conclusion: In the short term, patients on CPAP attained better PSG outcomes in terms of AHI reduction. Both MAD after DISE evaluation and CPAP resulted in similar improvements in clinical symptoms and health-related quality of life, even in patients with severe OSA.

Keywords: Continuous positive airway pressure; Drug-induced sleep endoscopy; Mandibular advancement device; Obstructive sleep apnea; Polysomnography.