Does Therapeutic Continuous Positive Airway Pressure Predict Success With an Oral Appliance in the Treatment of Obstructive Sleep Apnea

Abstract

PURPOSE: While continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA), compliance remains suboptimal. Oral appliance (OA) is an acceptable alternate to CPAP in those with mild OSA (apnea-hypopnea index [AHI] < 15/hr of sleep). Pressure requirement from CPAP is usually lower in mild OSA. Rather than OSA severity, we therefore, hypothesized that lower therapeutic CPAP requirement would better predict favorable response to OA. METHOD(S): We retrospectively collected data on all subjects who underwent a diagnostic and therapeutic polysomnogram (PSG), subsequent oral appliance therapy, and a follow up PSG or an overnight oximetry between 2006 and 2011. Residual AHI or oxygen desaturation index (ODI) was used to assess response to therapy. RESULT(S): Of the 123 subjects with an average age of 55.3 +/- 12.2 years, 60 were male. Average body mass index was 29.5 +/- 5.4 kg/m2 with an average neck circumference of 38.8 +/- 3.7 cm. Eighty subjects (65%) who required CPAP 7 cm H2O had resultant AHI/ODI of 7.4 +/- 6.6. Among those who required CPAP 15. Of these 24, 54% had resultant AHI/ODI < 5 while 79% had resultant AHI/ODI < 10 on the OA. Eighty-two subjects who had baseline AHI <15 had resultant AHI/ODI of 4.5 +/- 4.7. Of these 82 subjects, 72% had residual AHI/ODI < 5. Subjects with baseline AHI < 15 and final CPAP of < 5. CONCLUSION(S): Therapeutic CPAP requirement < 15 seem to better predict OA success than either pressure requirement or baseline AHI.