Keith Burgess (1,2), Andrew Burgess (2,3), Hedi Lamy (2), (1). Department of Medicine, University of Sydney. Sydney. NSW. 2050, (2). Peninsula Sleep Laboratory. Sydney. NSW. 2086, (3). Faculty of Medcine, Notre Dame University. Sydney. NSW. 2010, Australia

Abstract

Background:
Mandibular Advancement Devices (MADs) are now used more frequently to treat Obstructive Sleep Apnoea (OSA). Their effectiveness in practice is uncertain. Currently they are often thought of as providing treatment success in only 50% of patients. We suspected that using a second polysomnogram (PSG) to guide final adjustment would improve effectiveness.

Aim:
To objectively assess in the home the effectiveness of MADs in moderate severity OSA using our paradigm. Methods: We invited 200 subjects treated by the same algorithm to be restudied in their home environment. [Paradigm = Initial PSG, MAD advanced till “snoring controlled”, repeat PSG, further adjustment based on 2nd PSG]. 50 subjects (age 63±10, M:F 33:17) were studied with the MAD insitu by unattended PSG in their homes. (Somte PSG. Compumedics. Melbourne). All studies were scored by a certified technician not involved in the study, using R & K rules and “Chicago criteria”. (Snoring loudness was scored: 0=nil, 1=mild, 2=moderate, 3=loud, 4=very loud). The home studies with MAD in situ were compared to the original PSGs for sleep related variables and potential confounders. A variety of devices were used, though 65% were Somnodent. Treatment success was defined as normalisation of AHI or more than 50% reduction in AHI.

Results:
Total sleep time increased from 331±73 mins to 381±56 (P<001). Despite an increase in REM sleep from 15.8 ± 5.4% to 17.5 ± 4.9% (P=0.02), arousal index fell from 28 ± 13/hr sleep to 17 ± 8/hr at home (P<0.001). AHI fell from 21.8 ± 14/hr to 9.5 ± 9.8/hr (P<0.001), Desaturation below 90% fell from 4.7±12.4% sleep time to 2.3±4.9% (P=0.1). Snoring Score was reduced from 2.5 ± 0.7 to 1.7 ± 0.8 (P<0.001), BMI was unchanged at 28.6 ± 4.2. Supine sleep % was unchanged @ 38±26.

Conclusions:
In the home environment MADs reduced RDI by 56%, & desaturation below 90% by 51%. Treatment success occurred in 65% initially then in 70% subjects after final adjustment. There were no identified confounders. Conflict of interest: Yes

Published On: October 12th, 2010 /