Prevalence of residual excessive sleepiness during effective oral appliance therapy for sleep-disordered breathing

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• 作者：A.E.R. Verbruggen ; M. Dieltjens ; K. Wouters ; I. De Volder ; P.H. Van de Heyning ; M.J. Braem ; O.M. V ; erveken
• 关键词：Obstructive sleep apnea ; Mandibular advancement device ; Epworth Sleepiness Scale ; Daytime sleepiness ; Dental sleep medicine ; Sleep disordered breathing
• 刊名：Sleep Medicine
• 出版年：February, 2014
• 年：2014
• 卷：15
• 期：2
• 页码：269-272
• 全文大小：235 K

文摘

Background

Oral appliance therapy with a mandibular advancement device (OA_m) can yield to complete therapeutic response (apnea-hypopnea index [AHI] < 5 events/h), though some patients show little or no improvement in daytime sleepiness. The prevalence of residual excessive sleepiness (RES) despite effective treatment with OA_m therapy is unknown. We aimed to determine the prevalence of RES in patients treated with a titratable custom-made duobloc OA_m.

Methods

A prevalence study was performed, collecting data from 185 patients with an established diagnosis of sleep-disordered breathing (SDB) under OA_m therapy with a titratable custom-made duobloc device (baseline data were male:female ratio, 129:56; age, 48 卤 9 years; body mass index [BMI], 27 卤 4 kg/m²; Epworth Sleepiness Scale [ESS] score, 10 卤 5; and AHI, 19 卤 12 events/h). A full-night polysomnography was performed at baseline and after 3 months of OA_m therapy. Daytime sleepiness was assessed using the ESS with RES defined as an ESS score of 11 or higher out of 24, despite complete therapeutic response.

Results

Out of 185 patients, 84 patients (45%) showed a complete therapeutic response with an AHI of <5 events per hour after 3 months of OA_m therapy. Despite this normalization of AHI, 27 out of these 84 patients (32%) showed RES and had a significantly higher baseline ESS (15 卤 4 vs 9 卤 4; P < .001) and were younger (43 卤 9 vs 47 卤 9; P = .028) compared to patients without RES.

Conclusion

RES under OA_m therapy showed a prevalence of up to 32% in SDB patients effectively treated with respect to AHI. Patients with RES were younger and had higher baseline daytime sleepiness.