A pilot study to compare patient perception of obstructive sleep apnea treatment with CPAP or appliance therapy

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Statement of problem

The continuous positive airway pressure (CPAP) device yields optimum results in treating mild to moderate obstructive sleep apnea (OSA). However it may be bulky, noisy, and difficult to sleep with for the patient. Mandibular advancement devices (MAD) have shown better compliance but at the expense of lesser efficiency.

Purpose

The purpose of this study was to evaluate the patient's posttreatment subjective perception of the effectiveness of 2 common treatments of OSA.

Material and methods

Thirty-two patients diagnosed with OSA filled out the Epworth Sleepiness Scale and Berlin Sleep Quality Questionnaire before treatment and again at 4 to 6 weeks after treatment. Two groups were formed (n=16 each); one group was treated with MAD and the other with CPAP. The data obtained were recorded and compared with the Mann Whitney U test (between groups) and the Wilcoxon signed rank test (within groups) (α=.05).

Results

The analysis showed that the participants perceived significant posttreatment improvement (P<.05) for all variables of the Berlin Sleep Quality Questionnaire and the Epworth Sleepiness Scale for both the MAD and CPAP groups.

Conclusions

According to the questionnaires, participants perceived significant improvement in OSA symptoms after treatment in both the MAD and CPAP groups. The study was inconclusive as to whether improvement of perceived symptoms was higher with MAD or CPAP.

Section snippets

Material and Methods

The study was conducted in KG Medical University, Lucknow, India, in the Department of Prosthodontics in collaboration with the Pulmonary Medicine Department after receiving approval from the ethics committee. Patients older than 21 years and younger than 65 years diagnosed with mild to moderate OSA were recruited.

The screening of OSA patients was based on 1-night polysomnography,16 the ESS, and the BQ. The BQ, developed in 1996, comprises 10 questions and is well established in screening

Demographic data

The mean ±SD age of the study participants was 52.06 ±7.2 years (Table I). The age of the MAD group was 49.5 ±8.2 years (median 50 years). The age of the CPAP group was 51.5 ±7.3 years (median 51 years). Twenty-six participants were men (81.3%) and 6 were women (18.7 %). The mean BMI of the participants was 31.3 kg/m2. Approximately 6% of participants were normal weight, 38% were overweight, and 56% were obese. More than 75% of the participants were hypertensive, and a little less than half

Discussion

The null hypothesis of this study could not be rejected. Considering the nonparametric study distribution, the Mann-Whitney U test with 16 participants per group (mean scale score difference of 0.25 for snoring loudness between MAD and CPAP group; Table II) at α=.05 and 95% confidence interval provided a power of 74% (2-sided test). Greater improvement in BQ variables for the CPAP group (compared to the MAD group) was statistically insignificant.

The study used questionnaire-based scales in the

Conclusions

This pilot study found statistically significant posttreatment improvement in participant-perceived OSA symptoms evaluated with the BQ and ESS in both MAD and CPAP groups. An intergroup comparison of this improvement revealed a statistically insignificant difference.

Acknowledgment

The authors thank Prof. Anupam Mishra, Department of Otorhinolaryngology, KG Medical University, Lucknow, India; and Prof. Amit Nagar, Department of Orthodontics, KG Medical University, Lucknow, India.

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