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4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: A randomized study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
2002 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 121, no 3, 739-746 p.Article in journal (Refereed) Published
Abstract [en]

Study objectives: To evaluate the effects of treatment with a dental appliance or uvulopalato-pharyngoplasty, (UPPP) on somnographic variables in patients with mild-to-moderate obstructive sleep apnea (OSA) followed up for 4 years, and compliance,and complementary treatment.

Design: Randomized study.

Setting: Central Hospital, Västerås, Uppsala University, Sweden.

Patients: Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index (AI) > 5 and < 25) were randomized to treatment with a dental appliance or UPPP. Sleep studies were performed before and 1 year and 4 years after intervention. Thirty-two patients in the dental-appliance group and 40 patients in the UPPP group completed the 4-year follow-up.

Results: The success rate (percentage of patients with at least 50% reduction in AI) in the dental-appliance group was 81%, which was significantly higher than in the UPPP group, 53% (p < 0.05). Normalization (AI < 5 or apnea/hypopnea index < 10) was observed in 63% of the dental-appliance group and 33% of the UPPP group after 4 years. The difference between the groups was significant (p < 0.05). The compliance to use of the dental appliance was 62% at the 4-year follow-up. Thirty patients (75%) in the UPPP group continued without complementary treatment. The dental appliances had few adverse effects on the stomatognathic system, and the number of adjustments and repairs of the appliances over time was moderate. Pronounced complaints of nasopharyngeal regurgitation of fluid and difficulty, with swallowing after UPPP were reported by 8% and 10%, respectively.

Conclusions: The dental-appliance group showed significantly higher success and normalization rates regarding the somnographic variables compared to the UPPP group, but the effectiveness of the dental appliance was partly invalidated by the compliance of 62% at the 4-year follow-up. However, the appliances had few adverse effects on the stomatognathic system an required only moderate adjustments. Use of a dental appliance with regular follow-up can be recommended for long-term treatment of OSA.

Place, publisher, year, edition, pages
2002. Vol. 121, no 3, 739-746 p.
Keyword [en]
dental appliance, 4-year follow-up, obstructive sleep apnea, randomized controlled trial, randomized study, somnography, uvulopalatopharyngoplasty
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-90252DOI: 10.1378/chest.121.3.739ISI: 000174446000015OAI: oai:DiVA.org:uu-90252DiVA: diva2:162546
Available from: 2003-04-14 Created: 2003-04-14 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Treatment effects with a mandibular advancement appliance and uvulopalatopharyngoplasty in obstructive sleep apnea -randomised controlled trials-
Open this publication in new window or tab >>Treatment effects with a mandibular advancement appliance and uvulopalatopharyngoplasty in obstructive sleep apnea -randomised controlled trials-
2003 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Enthusiasm for uvulopalatopharyngoplasty (UPPP) in the treatment of mild-to-moderate obstructive sleep apnea syndrome (OSAS) has declined in recent years, partly because of a lower success rate over time and partly because of adverse effects. In more severe cases, the patients are generally treated with nasal continuous positive airway pressure (CPAP). However, many patients do not satisfactorily tolerate CPAP as a result of frequent side-effects. Consequently, there is a need for an alternative treatment. Reports on the beneficial effects of mandibular advancement appliances in the treatment of mild-to-moderate OSA exist in the form of short–term evaluations.

One of the aims of the present thesis was to compare treatment effects with a mandibular advancement appliance and UPPP in patients with OSA with follow-up after one and four years. Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index, AI >5 and <25) were randomised to treatment with a dental appliance or UPPP. Sleep studies were performed before and one and four years after intervention. According to the criteria for normalisation (AI<5 and apnea hypopnea index, AHI<10), 78% of the patients in the dental appliance group and 51% of the patients in the UPPP group had normalised after one year (p<0.05). Still after four years of treatment, 63% of the patients in the dental appliance group and 33% of the patients in the UPPP group were normalised. The dental appliance group had a higher normalisation rate than the UPPP group, but the efficacy was partly invalidated by the compliance rate of 62%.

Quality of life assessments in the dimensions of vitality, contentment and sleep improved in both groups at the one-year follow-up after treatment. There was no difference between the groups in terms of vitality and sleep. The UPPP group, however, reported a higher degree of contentment than the dental appliance group, even though the somnographic values were superior in the latter group.

Another aim was to conduct a randomised study to test the hypothesis that severe OSA patients will benefit from more pronounced mandibular advancement (MA) compared with a shorter advancement. Eighty-six males with severe OSA (AI>20) were randomly allocated to either 75% or 50% MA for a six-month treatment period. Treatment with a more pronounced mandibular advancement yielded a 20% higher normalisation rate than a shorter advancement. A mean normalisation rate of 45% was found for patients in this category with few side-effects, good patient satisfaction and a compliance of 92% after 6 months.

The overall conclusion is that dental appliance treatment is effective in patients with mild to moderate OSA and even for patients with severe OSA. The efficacy in terms of normalisation in patients with mild to moderate OSA was higher after the dental appliance treatment with a 50% degree of advancement than after the UPPP treatment. However, severe OSA patients might benefit from more pronounced advancement (75%) compared with a shorter degree of advancement (50%). QOL improved significantly after both dental appliance and UPPP treatment.

Place, publisher, year, edition, pages
Uppsala University Library, 2003. 88 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1240
Keyword
Physiology, oral appliance, dental appliance, obstructive sleep apnea, UPPP, quality of life, somnography, randomised controlled trial, one-year follow-up, four-year follow-up, severe obstructive sleep apnea, Fysiologi
National Category
Physiology
Research subject
Physiology
Identifiers
urn:nbn:se:uu:diva-3376 (URN)91-554-5578-6 (ISBN)
Public defence
2003-05-08, Robergssalen, ingång 40, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Available from: 2003-04-14 Created: 2003-04-14Bibliographically approved

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