Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD

PloS One
Hsiang-Wen LiuPei-Lin Lee

Abstract

This study aimed to determine the effect of combining positive airway pressure (PAP) therapy and mandibular advancement device (MAD) in patients with severe obstructive sleep apnea (OSA) who were pressure intolerant for PAP and were unresponsive to MAD. This retrospective study reviewed the medical records of severe OSA patients with apnea-hypopnea index (AHI) ≥ 30/hr who were diagnosed between October 1, 2008 and June 30, 2014. Patients were initially treated with 2 weeks of PAP, and those who were intolerant to high-pressure PAP (≥15 cm H2O) were switched to 12 weeks of MAD, which is a monobloc designed at 75% of maximum protrusion. Patients who had high residual AHI (≥15/hr) on MAD underwent 12 weeks of combination therapy (CT) with MAD and CPAP and were enrolled in the present study. Enrolled subjects who completed the 12-week CT were followed-up until June 30, 2016. A total of 14 male patients were included. All three treatments effectively reduced AHI, oxygen desaturation index (ODI), and total sleep time with SpO2 <90% (% TST-SpO2<90%) compared to pretreatment values. The residual AHI and ODI on CT was lower than that on MAD or PAP. The residual % TST-SpO2<90% was lower than that on MAD and similar to that on PAP. The th...Continue Reading

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Citations

Jul 27, 2018·Cranio : the Journal of Craniomandibular Practice·Valeria LuzziAntonella Polimeni
Dec 8, 2019·Journal of Clinical Medicine·Kate Sutherland, Peter A Cistulli
Apr 11, 2019·The Journal of International Medical Research·Ben-Gang PengXin Wang
Nov 11, 2020·Pulmonary Therapy·Claire E Francis, Tim Quinnell
Jan 19, 2021·Journal of Prosthodontics : Official Journal of the American College of Prosthodontists·Paul T Lee, Ryan R Sheridan
May 11, 2020·Sleep Medicine Clinics·Jing Hao Ng, Mimi Yow

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