Objective adherence to oral appliance therapy in patients with obstructive sleep apnea: a one-year longitudinal analysis.

Abstract

Introduction: Oral appliance (OA) therapy is widely used as an alternative to continuous positive airway pressure (CPAP) therapy for treating obstructive sleep apnea (OSA). Traditionally, OA adherence has been assessed through subjective self-reports before, but the availability of objective adherence sensors now allows for more accurate monitoring. This study aimed to analyze one-year objective adherence data to identify adherence patterns over time and factors influencing adherence to OA therapy.

Materials and methods: Fifty-five OSA patients were recruited from a cohort study and underwent clinical follow-ups at baseline, 1, 6 and 12 months. Patients were treated with custom-made, titratable OAs, and adherence was objectively collected using embedded sensors. Adherence data were analyzed using both intention-to-treat (ITT) and per-protocol (PP) approaches. Statistical methods, including comparative analyses, logistic regression models, and multivariate linear regression were performed to identify predictors of adherence.

Results: Twenty-one patients dropped out before the 12-month follow-up, leaving 34 completed the entire study. At the 1-month follow-up, 80.0% of patients were classified as adherent, with a mean wearing time of 5.98 ± 2.38 hours per night. By 6 months, adherence decreased to 67.3%, with a mean wearing time of 5.69 ± 2.08 hours per night. Several significant predictors of adherence were identified, including larger baseline overjet, younger age, and marital status.

Conclusions: OA adherence declined significantly within the first 6 months but stabilized between 6 and 12 months. Key baseline factors, such as larger overjet, younger age, and being married or partnered are predictors of better adherence, while psychological Comorbidities are associated with lower adherence.