Mandibular advancement device plus expiratory positive airway pressure favorable in OSA

Key takeaways:

• Researchers assessed an expiratory positive airway pressure enhanced mandibular advancement device (EMAD) against CPAP.
• At 6 months, the proportion of compliant patients was greater in the EMAD vs. CPAP group.

Patients with mild/moderate obstructive sleep apnea treated with a mandibular advancement device plus expiratory positive airway pressure reported improved sleep quality at 6 months, according to a study poster.

Findings on the poster presented at the European Respiratory Society International Congress also showed that this improvement was similar and, in some instances, greater than improvement reported by patients treated with CPAP, according to researchers.

In this study, Sat Sharma, MD, FRCPC, medical director of the Centre for Sleep and Chronobiology in Toronto, and colleagues evaluated 46 patients with mild or moderate OSA to determine how those treated with the O2Vent Optima (SleepWorks) mandibular advancement device (MAD) plus the ExVent (SleepWorks) expiratory positive airway pressure accessory (EMAD) differ from those treated with CPAP in compliance, sleep quality measures and respiratory event index at 6 months.

Sleep quality measures included Epworth Sleepiness Scale (ESS) scores, Stanford Sleepiness Scale (SSS) scores and Functional Outcomes of Sleep Questionnaire (FOSQ-10) scores.

Researchers also had access to patient level 1 polysomnographic sleep recordings and CPAP downloads.

At the 6-month mark, the proportion of compliant patients was greater in the EMAD vs. CPAP group (89.5% vs. 48.9%; P < .001).

Among those treated with EMAD, the ESS score improved from 12.8 at baseline to 7.9 at 6 months, and ESS improvement was also observed among those treated with CPAP (13.2 to 6.7).

Similarly, baseline SSS scores improved by month 6 in the EMAD group (3.4 to 2.2) and the CPAP group (3.3 to 2.2), according to researchers.

A higher FOSQ-10 score signals better sleep quality and was achieved by those receiving EMAD treatment (13.2 to 17.3) and those receiving CPAP treatment (13.9 to 17.8) at 6 months.

Using the reliable change index, researchers found a significantly higher proportion of EMAD-treated vs. CPAP-treated patients with an improved FOSQ global score (38.6% vs. 16.7%; P = .01).

Lastly, 84% of those treated with EMAD reached a respiratory event index of less than 10 events per hour at 6 months, which was comparable to the 93% of those treated with CPAP who also achieved this at 6 months.

“We conclude that MAD treatment should be considered a better treatment option than CPAP in mild and moderate OSA,” Sharma and colleagues wrote on the poster.