Published ahead of print on June 16, 2004, doi:10.1164/rccm.200311-1571OC
Am. J. Respir. Crit. Care Med., Volume 170, Number 6, September 2004, 656-664
A more recent version of this article appeared on September 15, 2004
Submitted on November 20, 2003
Accepted on June 15, 2004
Efficacy of Positive Airways Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea
Maree Barnes1*, R. Douglas McEvoy2, Siobhan Banks2, Natalie Tarquinio3, Christopher G Murray4, Norman Vowles5, and Robert J Pierce1
1 Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia,
2 Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia; Department of Medicine, Flinders University of South Australia, Bedford Park, South Australia, Australia,
3 Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia,
4 Dental Department, Austin Health, Melbourne, Victoria, Australia,
5 Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, South Australia, Australia
* To whom correspondence should be addressed. E-mail: maree.barnes{at}austin.org.au.
The efficacy of currently-recommended treatments is uncertain in patients with mild to moderate obstructive sleep apnea (apnea-hypopnea index 5-30). A group of 114 sleep clinic patients with apnea-hypopnea index 5-30 have participated in a randomized controlled crossover trial of 3 months treatment with each of nasal continuous positive airways pressure, a mandibular advancement splint and a placebo tablet. Outcomes were sleep fragmentation and hypoxemia, daytime sleepiness, quality of life, neurobehavioral function and blood pressure. Both active treatments improved sleep outcomes, but positive airways pressure had a greater effect. Quality of life, symptoms and subjective but not objective sleepiness improved to a similar degree with both treatments, however many of the improvements seen in neuropsychological function and mood were not better than the placebo effect. Some aspects of nocturnal blood pressure were improved with the splint but not with continuous positive airways pressure. This study has shown that although both continuous positive airways pressure and mandibular advancement splint effectively treated sleep-disordered breathing and sleepiness, the expected response in neurobehavioral function was incomplete. This may be due to the splint having a lesser therapeutic effect, and continuous positive airways pressure being poorly tolerated and therefore used less in this patient group.
Key words: Sleep Apnea Obstructive, Controlled Clinical Trials Randomized, Mandibular Advancement, Positive Pressure Ventilation
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