Long-term compliance with a mandibular protrusive appliance for treatment of obstructive sleep apnea

Objectives: Mandibular protrusive appliances (MPAs) are widely used to treat snoring and mild obstructive sleep apnoe/hypopnoea syndrome (OSAHS). The efficacy of this therapy has been proven in several clinical trials. Due to a lack of compliance with CPAP MPAs are considered as an alternative treatment option. The aim of the study was to evaluate the compliance of a MPA in the treatment of OSAHS. Methods: A retrospective questionnaire survey of a consecutive series of mild to moderate OSAHS patients treated with a MPA was performed. Attempts were made to contact all 193 patients treated between 1996/05 and 2001/09. Results: 105 persons (=54.4%) reported still using the MPA regularly after 22.7 ± 12.3 months. All patients were instructed to undertake a recall polysomnography (PSG) 6 weeks after the first insertion of the MPA. 21 patients (=10.9%) had no primary compliance and stopped wearing the device after 3.8 months without a recall. A primary treatment failure was seen in 19 patients (=9.8%). A secondary lack of compliance was observed in 22 patients (=11.4%) after 21.9 ± 8.8 months. 21 persons (=10.9%) showed a decrease in initial treatment success after 23.0 ± 11.7 months of appliance wear. In those patients treatment was changed to CPAP. A competing risk analysis was performed. After four years the estimate of the cumulative risk for still using the appliance as recommended was 32.2%. In the statistical evaluation the body mass index and the amount of upper and lower teeth correlated with a lack of MPA treatment. Reasons for stopping appliance use included side-effects, social circumstances, dental treatment, and a lack of perceived efficacy. Conclusions: Our results demonstrate that regular polysomnographic recalls are indicated. The compliance is affected by BMI, and the amount of upper and lower healthy teeth. Compliance with the used MPA seems to be as high as with CPAP.