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A Randomized Crossover Study of an Oral Appliance vs Nasal-Continuous Positive Airway Pressure in the Treatment of Mild-Moderate Obstructive Sleep Apnea
Section snippets
Subjects
Twenty-seven patients with symptomatic mild to moderate OSA (apnea and hypopnea index [AHI], 15 to 50/h of sleep during diagnostic laboratory polysomnography) were recruited for this study. Patients were unselected apart from a requirement that they have at least ten teeth in each of the maxillary and mandibular arches, and reside in the metropolitan Vancouver area. All patients were seen in the Sleep Disorders Clinic at the Vancouver Hospital and Health Sciences Center between November 1991
RESULTS
Twenty-seven patients were recruited, including 24 men and 3 women. These patients were, in general, middle aged, overweight, and had mild to moderate OSA (Table 1). One patient dropped out during the wash-in period after the N-CPAP titration night and another patient dropped out early in the first treatment period with the OA when he moved out of town. All subsequent results are presented on the remaining 25 patients.
There was no carryover effect between the treatment periods and no period
DISCUSSION
This study is one of the first randomized, prospective crossover studies comparing an OA to N-CPAP in the treatment of an unselected group of patients with OSA. We have shown that OAs are an effective treatment in some patients with mild to moderate OSA. Forty-eight percent of the OA group were treatment successes compared to 62% of the N-CPAP group. The 3 patients in the OA group with an AHI greater than 40/h were all treatment failures. However, 2 of these 3 patients had a 75% reduction in
ACKNOWLEDGMENTS
The authors thank Leslie Love for technical assistance, Dr. Barry Wiggs for statistical advice, and Bernice Robillard for assistance with preparation of the manuscript.
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Supported by a British Columbia Lung Association Research Grant.
Nasal CPAP machines were provided by Respironics Inc, Mur-raysville, Pa (REMstar Choice) and ARS VitalAire, Vancouver, BC (Healthdyne Tranquillity Plus).