Authors (including presenting author) :
Kwan HY(1), Tang WK(2), Ho HW(2), Ling SO(1), Man LS(2),Ma O(1), Poon YN(1), Yau APY(1), Yim CW(1), Mok YW(1)
Affiliation :
(1)Department of Respiratory Medicine, Kowloon Hospital, (2)Sleep laboratory, Department of Respiratory Medicine, Kowloon Hospital
Introduction :
Obstructive sleep apnoea (OSA) is a common sleep disorder that is associated with multiple adverse health outcomes including cardiovascular diseases, metabolic syndromes, and depression. The risks for developing these co-morbidities and all-cause mortality are particularly high if it is left untreated. Positive airway pressure (PAP) is the most common and efficacious treatment. However many patients could not tolerate PAP, leading to poor treatment compliance and outcomes. Some patients even refuse treatment. Oral appliance (OA) is recommended for patients who cannot tolerate PAP, but it is not a routine practice in Hong Kong(HK).
Objectives :
To evaluate the efficacy of OA in OSA patients and their compliance.
Methodology :
From 1.1.2016 to 31.12.2017, 48 OSA patients underwent follow-up sleep studies (PSG) wearing their customized OA in sleep laboratory in Department of Respiratory Medicine (RMD) of Kowloon Hospital (KH). They all either refused or could not tolerate PAP, and were considered eligible for OA by dental surgeons. Thirty-five of them are males (73%). Their mean(SD) age is 54(11); mean (SD) BMI is 25.9(3.8)kg/m2; mean (SD) neck circumference 38.3(3.4)cm; and their mean (SD) Epworth Sleepiness Scale(ESS) is 11(4). Their disease severity was determined by the apnoea-hypopnoea index(AHI) of their baseline PSG: 20(42%) of them have mild; 18(38%) of them have moderate; and 10(21%) of them have severe OSA. OA responder is defined as either: 1. AHI reduced to <5/h; or 2. AHI reduced to <10/h and >50% reduction in baseline AHI; or 3. >50% reduction in baseline AHI. Patients who fulfilled none of these criteria were considered OA failure. Their compliance to OA treatment was evaluated.
Result & Outcome :
Nineteen (40%) of all studied patients are OA responders. OA response rates in mild 7(35%), moderate 9(50%), and severe 3(30%) OSA are similar (p=0.118). Compliance rate to OA among responders is 89.5%, considering that none of them would be receiving OSA treatment otherwise. OA is effective for OSA patients irrespective of their disease severity. OA responders complied well with treatment. It is a useful alternative for OSA patients who could not tolerate PAP and could improve treatment outcomes. We therefore recommend that all OSA patients who could not tolerate or refused using PAP, should be referred to dental surgeons for OA feasibility assessment, followed by repeating PSG with their well-fitted OA to evaluate its efficacy. Such practice could help optimizing OSA management.
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