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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea</title>
<author><name sortKey="Lettieri, Christopher J" sort="Lettieri, Christopher J" uniqKey="Lettieri C" first="Christopher J." last="Lettieri">Christopher J. Lettieri</name>
<affiliation><nlm:aff id="aff1">Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff2">Department of Medicine, Uniformed Services University, Bethesda, MD</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Paolino, Nathalie" sort="Paolino, Nathalie" uniqKey="Paolino N" first="Nathalie" last="Paolino">Nathalie Paolino</name>
<affiliation><nlm:aff id="aff3">Department of Medicine, Walter Reed Army Medical Center, Washington, DC</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Eliasson, Arn H" sort="Eliasson, Arn H" uniqKey="Eliasson A" first="Arn H." last="Eliasson">Arn H. Eliasson</name>
<affiliation><nlm:aff id="aff1">Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff2">Department of Medicine, Uniformed Services University, Bethesda, MD</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Shah, Anita A" sort="Shah, Anita A" uniqKey="Shah A" first="Anita A." last="Shah">Anita A. Shah</name>
<affiliation><nlm:aff id="aff2">Department of Medicine, Uniformed Services University, Bethesda, MD</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Holley, Aaron B" sort="Holley, Aaron B" uniqKey="Holley A" first="Aaron B." last="Holley">Aaron B. Holley</name>
<affiliation><nlm:aff id="aff1">Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff2">Department of Medicine, Uniformed Services University, Bethesda, MD</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">22003337</idno>
<idno type="pmc">3190841</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190841</idno>
<idno type="RBID">PMC:3190841</idno>
<idno type="doi">10.5664/JCSM.1300</idno>
<date when="2011">2011</date>
<idno type="wicri:Area/Pmc/Corpus">002414</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002414</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea</title>
<author><name sortKey="Lettieri, Christopher J" sort="Lettieri, Christopher J" uniqKey="Lettieri C" first="Christopher J." last="Lettieri">Christopher J. Lettieri</name>
<affiliation><nlm:aff id="aff1">Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff2">Department of Medicine, Uniformed Services University, Bethesda, MD</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Paolino, Nathalie" sort="Paolino, Nathalie" uniqKey="Paolino N" first="Nathalie" last="Paolino">Nathalie Paolino</name>
<affiliation><nlm:aff id="aff3">Department of Medicine, Walter Reed Army Medical Center, Washington, DC</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Eliasson, Arn H" sort="Eliasson, Arn H" uniqKey="Eliasson A" first="Arn H." last="Eliasson">Arn H. Eliasson</name>
<affiliation><nlm:aff id="aff1">Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff2">Department of Medicine, Uniformed Services University, Bethesda, MD</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Shah, Anita A" sort="Shah, Anita A" uniqKey="Shah A" first="Anita A." last="Shah">Anita A. Shah</name>
<affiliation><nlm:aff id="aff2">Department of Medicine, Uniformed Services University, Bethesda, MD</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Holley, Aaron B" sort="Holley, Aaron B" uniqKey="Holley A" first="Aaron B." last="Holley">Aaron B. Holley</name>
<affiliation><nlm:aff id="aff1">Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff2">Department of Medicine, Uniformed Services University, Bethesda, MD</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine</title>
<idno type="ISSN">1550-9389</idno>
<idno type="eISSN">1550-9397</idno>
<imprint><date when="2011">2011</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec><title>Study Objectives:</title>
<p>To compare the efficacy of adjustable and fixed oral appliances for the treatment of OSA.</p>
</sec>
<sec><title>Methods:</title>
<p> Retrospective review of consecutive patients with OSA treated with either adjustable or fixed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defined as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared efficacy rates between fixed and adjustable appliances and sought to identify factors associated with greater success.</p>
</sec>
<sec><title>Results:</title>
<p> We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fixed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was significantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fixed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fixed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease.</p>
</sec>
<sec><title>Conclusions:</title>
<p> Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance.</p>
</sec>
<sec><title>Citation:</title>
<p> Lettieri CJ; Paolino N; Eliasson AH; Shah AA; Holley AB. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. <italic>J Clin Sleep Med</italic>
2011;7(5):439-445.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Clin Sleep Med</journal-id>
<journal-id journal-id-type="publisher-id">JCSM</journal-id>
<journal-title-group><journal-title>Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">1550-9389</issn>
<issn pub-type="epub">1550-9397</issn>
<publisher><publisher-name>American Academy of Sleep Medicine</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">22003337</article-id>
<article-id pub-id-type="pmc">3190841</article-id>
<article-id pub-id-type="doi">10.5664/JCSM.1300</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>New Research</subject>
<subj-group><subject>Scientific Investigations</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Lettieri</surname>
<given-names>Christopher J.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Paolino</surname>
<given-names>Nathalie</given-names>
</name>
<degrees>D.O.</degrees>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Eliasson</surname>
<given-names>Arn H.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Shah</surname>
<given-names>Anita A.</given-names>
</name>
<degrees>D.O.</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Holley</surname>
<given-names>Aaron B.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<aff id="aff1"><label>1</label>
Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC</aff>
<aff id="aff2"><label>2</label>
Department of Medicine, Uniformed Services University, Bethesda, MD</aff>
<aff id="aff3"><label>3</label>
Department of Medicine, Walter Reed Army Medical Center, Washington, DC</aff>
</contrib-group>
<author-notes><corresp id="cor1">Address correspondence to: Christopher J. Lettieri, M.D., <addr-line>Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington DC, 20307</addr-line>
<phone>(202) 782-5720</phone>
<fax>(202) 782-9032</fax>
<email>christopher.lettieri@us.army.mil</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><day>15</day>
<month>10</month>
<year>2011</year>
</pub-date>
<volume>7</volume>
<issue>5</issue>
<fpage>439</fpage>
<lpage>445</lpage>
<history><date date-type="received"><month>3</month>
<year>2011</year>
</date>
<date date-type="rev-recd"><month>6</month>
<year>2011</year>
</date>
<date date-type="accepted"><month>6</month>
<year>2011</year>
</date>
</history>
<permissions><copyright-statement>© 2011 American Academy of Sleep Medicine</copyright-statement>
<copyright-year>2011</copyright-year>
</permissions>
<abstract><sec><title>Study Objectives:</title>
<p>To compare the efficacy of adjustable and fixed oral appliances for the treatment of OSA.</p>
</sec>
<sec><title>Methods:</title>
<p> Retrospective review of consecutive patients with OSA treated with either adjustable or fixed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defined as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared efficacy rates between fixed and adjustable appliances and sought to identify factors associated with greater success.</p>
</sec>
<sec><title>Results:</title>
<p> We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fixed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was significantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fixed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fixed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease.</p>
</sec>
<sec><title>Conclusions:</title>
<p> Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance.</p>
</sec>
<sec><title>Citation:</title>
<p> Lettieri CJ; Paolino N; Eliasson AH; Shah AA; Holley AB. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. <italic>J Clin Sleep Med</italic>
2011;7(5):439-445.</p>
</sec>
</abstract>
<kwd-group><kwd>Oral appliance</kwd>
<kwd>mandibular advancement device</kwd>
<kwd>obstructive sleep apnea</kwd>
<kwd>efficacy</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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