Initial Evaluation of a Titration Appliance for Temporary Treatment of Obstructive Sleep Apnea
|Daniel J. Levendowski1*, Todd Morgan2 and Philip Westbrook1|
|1Advanced Brain Monitoring Inc., Carlsbad, USA|
|2Scripps Dental Group, Carlsbad, USA|
|Corresponding Author :||Dr. Daniel J. Levendowski
Advanced Brain Monitoring Inc.,
237 Faraday Avenue, Suite, 100
Carlsbad, CA 92008, USA
E-mail: [email protected]
|Received December 13, 2011; Accepted December 18, 2011; Published December 24, 2011|
|Citation: Levendowski DJ, Morgan T, Westbrook P (2011) Initial Evaluation of a Titration Appliance for Temporary Treatment of Obstructive Sleep Apnea. J Sleep Disord Ther 1:101. doi:10.4172/2167-0277.1000101|
|Copyright: © 2011 Levendowski DJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Background: Custom oral appliances that adjustably advance the mandible provide superior outcomes when treating patients with moderate or severe sleep apnea. Custom appliances, however, are expensive, must be fitted by a dentist, and the likelihood of successful outcomes are difficult to predict. An inexpensive trial appliance, if proven efficacious, might be used to predict custom appliance outcomes or to provide temporary therapeutic benefit.
Objective: The aim of this initial study was to assess the treatment efficacy of a novel titration oral appliance with that of an optimized custom appliance.
Methods: Seventeen patients, treated with a custom oral appliance for at least one year, successfully completed a three-night home sleep test. The baseline obstructive sleep apnea severity was established on Night 1 with seven patients exhibiting severe, six moderate and four mild apnea/hypopnea indexes. Patients were randomly assigned to wear their custom appliance or the titration appliance on Nights 2 and 3.
Results: Significant reductions in the mean overall and supine apnea indexes (p < 0.05), and the overall (p < 0.01) and supine (p < 0.05) apnea/hypopnea indexes were observed for both the titration and custom appliances. The proportion of patients who exhibited at least a 50% reduction in the overall apnea index and supine apnea/hypopnea were similar for the titration and custom appliance (~60%). The custom appliance reduced the overall apnea/hypopnea index by 50% in a greater proportion of the patients compared to the titration appliance (77% vs. 53%). The titration appliance significantly reduced the degree of hypoxic exposure across sleep disordered breathing events overall (p < 0.05) and supine (p < 0.01). Patients found their custom appliance was more comfortable than the titration appliance, but preferred the titration appliance to no therapy.
Conclusion: The titration appliance may be useful in assessing oral appliance treatment efficacy. When set to 70% of maximum protrusion, the titration appliance may provide immediate, temporary therapeutic benefit.