Long-term mandibular advancement appliance therapy for obstructive sleep apnea: Adherence and outcomes over 10 years.

Abstract

Background: The authors evaluated patients who received a diagnosis of obstructive sleep apnea (OSA) and were treated with a mandibular advancement appliance (MAA) for more than 10 years.

Methods: In a cohort of 839 patients who received a diagnosis of OSA and initiated MAA therapy for a period exceeding 10 years, a subset of 298 patients underwent both pretreatment and posttitration polysomnography. These patients participated in a survey conducted through an electronically distributed, questionnaire-based method. The analysis encompassed participants' perceived enhancement in symptoms of OSA and the satisfaction levels reported by the participants. In addition, the authors investigated the factors affecting adherence to and discontinuation of the treatment through a stepwise forward binary logistic regression analysis.

Results: A total of 121 patients (54.5%) returned the questionnaire. The main reason for seeking treatment was that their snoring was disturbing a bed partner (77.6%). Factors associated with long-term adherence included experiencing morning headaches before treatment (odds ratio [OR], 32.11; 95% CI, 2.52 to 404.13; P = .007), perception that MAA therapy improves sleep (OR, 6.58; 95% CI, 1.58 to 27.38; P = .01), bed partner satisfaction with MAA therapy (OR, 4.12; 95% CI, 1.64 to 10.36; P = .003), and perception of irritability as a motivating factor for seeking treatment (B = -3.64; OR, 0.026; 95% CI, 0.002 to 0.412; P = .009).

Conclusions: Results of long-term MAA therapy for OSA, with more than a decade of use, showed significant benefits in improving self-perception of OSA symptoms, reducing daytime sleepiness, and enhancing partner satisfaction.

Practical implications: Understanding the factors influencing long-term adherence or nonadherence to OSA treatment with MAA is essential for sustaining the health and quality of life of the patients affected.