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Randomized Controlled Trial
. 2019 Nov 15;15(11):1655-1663.
doi: 10.5664/jcsm.8034.

Long-Term Objective Adherence to Mandibular Advancement Device Therapy Versus Continuous Positive Airway Pressure in Patients With Moderate Obstructive Sleep Apnea

Grietje E de Vries  1   2 , Aarnoud Hoekema  3   4   5   6 , Johannes Q P J Claessen  7 , Cornelis Stellingsma  3 , Boudewijn Stegenga  3   8 , Huib A M Kerstjens  1   2 , Peter J Wijkstra  1   2   9
Affiliations
Randomized Controlled Trial

Long-Term Objective Adherence to Mandibular Advancement Device Therapy Versus Continuous Positive Airway Pressure in Patients With Moderate Obstructive Sleep Apnea

Grietje E de Vries et al. J Clin Sleep Med. .

Abstract

Study objectives: Comparable health effects of mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy have been attributed to higher adherence with MAD compared with CPAP therapy. The objective of this study was to make a direct comparison of the objective adherence between MAD and CPAP in patients with moderate obstructive sleep apnea (OSA).

Methods: Adherence was monitored for 12 months in 59 patients with moderate OSA (apnea-hypopnea index 15-30 events/h) as part of a randomized controlled trial. Objective adherence with MAD was assessed using the TheraMon microsensor. Objective adherence with CPAP was assessed using the built-in registration software with readout on SD card. Self-reported adherence with both therapies was assessed using a questionnaire.

Results: Forty patients (68%) completed the study with the therapy to which they were randomly assigned. Median (interquartile range) objective adherence (h/night) in the 3rd month was 7.4 (5.2-8.2) for MAD and 6.8 (5.7-7.6) for CPAP (P = .41), compared to 6.9 (3.5-7.9) with MAD and 6.8 (5.2-7.6) with CPAP (P = .85) in the 12th month. There were no significant changes between the 3rd and 12th month for both MAD (P = .21) and CPAP (P = .46). Changes in adherence were not significantly different between MAD and CPAP (P = .51). Self-reported adherence was significantly higher with MAD than CPAP at all follow-ups. Self-reported adherence with CPAP was lower than objective CPAP adherence at the 6th and 12th month (P = .02).

Conclusions: Objective adherence with MAD and CPAP is comparable and consistent over time. Self-reported adherence is higher with MAD than with CPAP giving rise to interesting discrepancy between objective and self-reported adherence with CPAP.

Clinical trial registration: Registry: ClinicalTrials.gov; Identifier: NCT01588275.

Keywords: patient adherence; randomized controlled trial; sleep apnea.

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Figures

Figure 1
Figure 1. Flowchart available objective data MAD and CPAP therapy.
AHI = apnea-hypopnea index, CPAP = continuous positive airway pressure, MAD = mandibular advancement device, OSA = obstructive sleep apnea, PSG = polysomnography, SAS = sleep apnea syndrome.
Figure 2
Figure 2. Objective and self-reported adherence in the 3rd, 6th and 12th month with MAD and CPAP.
Boxplots represent the median and interquartile ranges, whiskers represent the minimum and maximum. (A) Median h/night measured over all nights. (B) Median h/night measured over the nights when device was used. (C) Self-reported median h/night measured over the nights when device was used. CPAP = continuous positive airway pressure, MAD = mandibular advancement device.
Figure 3
Figure 3. Mean usage for MAD and CPAP therapy over 365 days.
Days 181-264 of MAD could not be displayed as the memory card can only store from the preceding 100 days and therefore data is missing for this specific time period. CPAP = continuous positive airway pressure, MAD = mandibular advancement device.
See this image and copyright information in PMC

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