P031 A Novel Oral Appliance Implementation Protocol Using Nightly Portable Monitoring for OSA Patients Failing CPAP therapy

I Ling, J Christoforou, G Chin, P Currie
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Abstract

Abstract Introduction Oral Appliance Therapy (OAT) is an effective second line treatment for OSA. However, OAT devices do not have active efficacy monitoring, hence little is known about methods to best identify the optimal degree of mandibular advancement. Methods Consecutive OSA patients undergoing OAT at a sleep disorders service were recruited to participate in a novel titration protocol using nightly monitoring via a portable device (NightOwl®, Ectosense, Belgium). Demographic & sleep study (PSG) data, and key NightOwl® metrics were collected. A treatment PSG was conducted at conclusion of OAT implementation using identified optimal point of mandibular advancement. Results 80 subjects were recruited (52 male, 65%) with mean (±SD) age 49±12 years, BMI 28±4.4 kg/m2, Epworth score (ESS) 9.1±4.9. Baseline PSG showed mean AHI 28±20 events/hr, nadir SpO2 84±21%, time SpO2<90% 8.3±30 minutes. Blood pressure monitoring at baseline showed mean day BP 123/70mmHg and night BP 106/57mmHg. The mean mandibular advancement implemented was 2.9±1.7mm. Post treatment mean ESS was 5.1±3.5 (p<0.001). 62/68 (91%) subjects reported perceived benefit on OAT, 49/53 (92%) reduced snoring, 51/62 (82%) improved sleep, 49/62 (79%) increased energy. Treatment PSG on completion of the protocol showed AHI 14±10 events/hr (p<0.001), nadir SpO2 82±33% (p>0.05), time SpO2<90% 1.2±21 minutes (p=0.04). 48/63 (76%) met the AHI definition of OAT success. Discussion This study demonstrates a novel OAT protocol which led to minimal degree of mandibular advancement, resulting in high rates of symptom benefit and effective treatment of OSA.
CPAP治疗失败的OSA患者夜间便携式监测的新型口腔器械实施方案
口腔器械治疗(Oral Appliance Therapy, OAT)是OSA有效的二线治疗方法。然而,OAT装置没有主动的疗效监测,因此很少知道如何最好地确定下颌前进的最佳程度。方法招募在睡眠障碍服务中心接受OAT治疗的连续OSA患者,通过便携式设备(NightOwl®,Ectosense, Belgium)进行夜间监测,参与一项新的滴定方案。人口,收集睡眠研究(PSG)数据和关键的NightOwl®指标。在OAT实施结束时,使用确定的下颌前进最佳点进行治疗PSG。结果共纳入80例受试者,其中男性52例,占65%,平均(±SD)年龄49±12岁,BMI 28±4.4 kg/m2, Epworth评分(ESS) 9.1±4.9。基线PSG显示平均AHI 28±20事件/小时,最低点SpO2 84±21%,时间SpO2<90% 8.3±30分钟。基线血压监测显示日均血压123/70mmHg,夜间血压106/57mmHg。下颌平均前移2.9±1.7mm。治疗后平均ESS为5.1±3.5 (p<0.001)。62/68(91%)的受试者报告了OAT的益处,49/53(92%)减少了打鼾,51/62(82%)改善了睡眠,49/62(79%)增加了精力。方案完成时PSG显示AHI 14±10事件/小时(p=0.04),最低点SpO2 82±33% (p=0.04), SpO2<90%时间1.2±21分钟(p=0.04)。48/63(76%)符合AHI对OAT成功的定义。本研究展示了一种新的OAT方案,该方案可使下颌前移程度最小,从而导致高症状缓解率和OSA的有效治疗。
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