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10.08.2022 | Sleep Breathing Physiology and Disorders • Original Article

Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA

verfasst von: Gabriela Pontes Luz, Luciana Badke, Luiz Eduardo Nery, Luciana Oe Silva, Thais Moura Guimarães, Glaury Coelho, Aline Millani, Rodrigo Gomes Alves, Camila Kase, Sergio Tufik, Lia Bittencourt

Erschienen in: Sleep and Breathing | Ausgabe 3/2023

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Abstract

Objective

This study’s objective was to compare the best long-term treatment, mandibular advancement device (MAD) or continuous positive airway pressure (CPAP), for patients with mild obstructive sleep apnea (OSA) in improving excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life.

Methods

This study was a single-blind, parallel, randomized clinical trial with controls. The sample was composed of individuals between 18 and 65 years of age with a body mass index of < 35 kg/m² and apnea/hypopnea index above five and less than 15. Participants were submitted to physical examination, polysomnography, and the following questionnaires: Pittsburgh Sleep Quality Index, Berlin Questionnaire, Epworth Sleepiness Scale, Stanford Sleepiness Scale, Karolinska Sleepiness Scale, Modified Fatigue Impact Scale, Functional Outcomes of Sleep Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory. They were also presented with the following tests: maintenance of wakefulness test and psychomotor vigilance task.

Results

Of 79 patients, 25 were in the MAD group, 31 in the CPAP group, and 23 in the control group. Polysomnographic parameters were best normalized with CPAP compared with MAD. Fatigue was improved in the MAD and CPAP groups, with no difference between these treatments. Quality of life was also improved with both treatments, but CPAP was superior to MAD. Daytime sleepiness, mood, and sustained attention showed no difference with the interventions. Greater adherence was obtained with MAD patients than with CPAP measured by hours of use.

Conclusions

Treatment with CPAP was better at normalizing polysomnographic parameters and improving quality of life in patients with mild OSA. Both treatments improved fatigue with no difference between the two treatments. Neither treatment improved daytime sleepiness, mood or sustained attention.

Clinical Trials Database

NTC01461486.

Luz GP, Guimarães TM, Weaver TE et al (2016) Impaired sustained attention and lapses are present in patients with mild obstructive sleep apnea. Sleep Breath 20(2):681–687. https://doi.org/10.1007/s11325-015-1279-7CrossRefPubMed

de Godoy LB, Luz GP, Palombini LO et al (2016) Upper airway resistance syndrome patients have worse sleep quality compared to mild obstructive sleep apnea. PLoS ONE 11(5):0156244. https://doi.org/10.1371/journal.pone.0156244CrossRef

Oliveira E, Silva L, Guimarães TM, Luz GP et al (2021) The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild obstructive sleep apnea: a randomized controlled study. Sleep Breath 25(2):797–805. https://doi.org/10.1007/s11325-020-02183-1CrossRef

Kushida CA, Morgenthaler TI, Littner MR, American Academy of Sleep et al (2006) Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005. Sleep 29(2):240–3. https://doi.org/10.1093/sleep/29.2.240CrossRefPubMed

Kushida CA, Nichols DA, Holmes TH et al (2012) Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long- term Efficacy Study (APPLES). Sleep 35(12):1593–1602. https://doi.org/10.5665/sleep.2226CrossRefPubMedPubMedCentral

Weaver TE, Mancini C, Maislin G et al (2012) Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med 186(7):677–683. https://doi.org/10.1164/rccm.201202-0200OCCrossRefPubMedPubMedCentral

Chowdhuri S, Quan SF, Almeida F, ATS Ad Hoc Committee on Mild Obstructive Sleep Apnea et al (2016) An Official American Thoracic Society Research Statement: Impact of Mild Obstructive Sleep Apnea in Adults. Am J Respir Crit Care Med 193(9):37–54. https://doi.org/10.1164/rccm.201602-0361^STCrossRef

American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research The report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):667–89CrossRef

American Academy of Sleep Medicine (2005) International classification of sleep disorders, 2nd edn. Diagnostic and coding manual (ICSD-2). American Academy of Sleep Medicine, Westchester

10.

Iber C, Ancoli-Israel S, Chesson AL Jr et al (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, Westchester

11.

Bertolazi AN, Fagondes SC, Hoff LS et al (2011) Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med 12(1):70–75CrossRefPubMed

12.

Netzer NC, Stoohs RA, Netzer CM et al (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491CrossRefPubMed

13.

Bertolazi AN, Fagondes SC, Hoff LS et al (2009) Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 35(9):877–883CrossRefPubMed

14.

Akerstedt T, Gillberg M (1990) Subjective and objective sleepiness in the active individual. Int J Neurosci 52(1–2):29–37CrossRefPubMed

15.

Hoddes E, Zarcone V, Smythe H et al (1973) Quantification of sleepiness: a new approach. Psychophysiology 10(4):431–436CrossRefPubMed

16.

Pavan K, Schmidt K, Marangoni B et al (2007) Adaptação transcultural e validação da escala modificada de impacto de fadiga. ArqNeuropsiquiatr 65(3-A):669–73

17.

Cunha JA (2001) Manual da versão em português das Escalas Beck. Casa do Psicólogo, São Paulo

18.

Weaver TE, Laizner AM, Evans LK et al (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20(10):835–843PubMed

19.

Dinges DF, Powell JW (1985) Microcomputer analyses of performance on a portable, simple visual RT task during sustained operations. Behavior Research 17:652–655

20.

Sullivan S, Kushida C (2008) Multiple sleep latency test and maintenance of wakefulness test. Chest 134:854–861CrossRefPubMed

21.

Kushida CA, Chediak A, Berry RB, American Academy of Sleep Medicine. Positive Airway Pressure Titration Task Force et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–71CrossRefPubMed

22.

Dal-Fabbro C, Chaves-Junior CM, Bittencourt LRA et al (2010) Clinical and polysomnographic assessment of the BRD Appliance in the treatment of Obstructive Sleep Apnea Syndrome. Dental Press J Orthod 15:107–117CrossRef

23.

Barnes M, McEvoy RD, Banks S et al (2004) Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170(6):656–64. https://doi.org/10.1164/rccm.200311-1571OCCrossRefPubMed

24.

Marshall NS, Neill AM, Campbell AJ et al (2005) Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea. Thorax 60(5):427–432. https://doi.org/10.1136/thx.2004.032078CrossRefPubMedPubMedCentral

25.

Marklund M, Carlberg B, Forsgren L et al (2015) Oral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea: a randomized clinical trial. JAMA Intern Med 175(8):1278–1285. https://doi.org/10.1001/jamainternmed.2015.2051CrossRefPubMed

26.

Aarab G, Lobbezoo F, Heymans MW et al (2011) Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration 82(2):162–168. https://doi.org/10.1159/000324580CrossRefPubMed

27.

Guimarães TM, Poyares D, Silva LO et al (2021) The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one year of treatment. J Clin Sleep Med 17(2):149–158. https://doi.org/10.5664/jcsm.8822CrossRefPubMedPubMedCentral

28.

Kim H, Thomas RJ, Yun CH et al (2017) Association of mild obstructive sleep apnea with cognitive performance, excessive daytime sleepiness, and quality of life in the general population: The Korean Genome and Epidemiology Study (KoGES). Sleep 40(5). https://doi.org/10.1093/sleep/zsx012

29.

Lee SA, Paek JH, Han SH (2015) Sleep hygiene and its association with daytime sleepiness, depressive symptoms, and quality of life in patients with mild obstructive sleep apnea. J Neurol Sci 359:445–449. https://doi.org/10.1016/j.jns.2015.10.017CrossRefPubMed

Titel: Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA
verfasst von: Gabriela Pontes Luz
Luciana Badke
Luiz Eduardo Nery
Luciana Oe Silva
Thais Moura Guimarães
Glaury Coelho
Aline Millani
Rodrigo Gomes Alves
Camila Kase
Sergio Tufik
Lia Bittencourt
Publikationsdatum: 10.08.2022
Verlag: Springer International Publishing
Erschienen in: Sleep and Breathing / Ausgabe 3/2023
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-022-02694-z

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Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA