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      Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial

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          Abstract

          Purpose

          The Sleep Position Trainer (SPT) is a new option for treating patients with positional obstructive sleep apnea (POSA). This study investigated long-term efficacy, adherence, and quality of life during use of the SPT device compared with oral appliance therapy (OAT) in patients with POSA.

          Methods

          This prospective, multicenter trial randomized patients with mild to moderate POSA (apnea-hypopnea index [AHI] 5–30/h) to SPT or OAT. Polysomnography was performed at baseline and after 3 and 12 months’ follow-up. The primary endpoint was OSA severity; adherence, quality of life, and adverse events were also assessed.

          Results

          Ninety-nine patients were randomized and 58 completed the study (29 in each group). Median AHI in the SPT group decreased from 13.2/h at baseline to 7.1/h after 12 months ( P < 0.001); corresponding values in the OAT group were 13.4/h and 5.0/h ( P < 0.001), with no significant between-group difference ( P = 1.000). Improvements throughout the study were maintained at 12 months. Long-term median adherence was also similar in the two treatment groups; the proportion of patients who used their device for ≥ 4 h for 5 days in a week was 100% in the SPT group and 97.0% in the OAT group ( P = 0.598).

          Conclusions

          The efficacy of SPT therapy was maintained over 12 months and was comparable to that of OAT in patients with mild to moderate POSA. Adherence was relatively high, and similar in the two groups.

          Trial registration:

          www.clinicaltrials.gov (NCT02045576).

          Electronic supplementary material

          The online version of this article (10.1007/s11325-017-1568-4) contains supplementary material, which is available to authorized users.

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          Most cited references25

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          • Article: not found

          A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions.

          Continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA) but adherence to the treatment limits its overall effectiveness across all age groups of patients. Factors that influence adherence to CPAP include disease and patient characteristics, treatment titration procedures, technological device factors and side effects, and psychological and social factors. These influential factors have guided the development of interventions to promote CPAP adherence. Various intervention strategies have been described and include educational, technological, psychosocial, pharmacological, and multi-dimensional approaches. Though evidence to date has led to innovative strategies that address adherence in CPAP-treated children, adults, and older adults, significant opportunities exist to develop and test interventions that are clinically applicable, specific to sub-groups of patients likely to demonstrate poor adherence, and address the multi-factorial nature of CPAP adherence. The translation of CPAP adherence promotion interventions to clinical practice is imperative to improve health and functional outcomes in all persons with CPAP-treated OSA. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            • Article: not found

            Obstructive sleep apnea.

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              Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis.

              A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. We found that the published literature is comprised primarily of case series, with few controlled trials and varying approaches to pre-operative evaluation and post-operative follow-up. We include surgical morbidity and adverse events where reported but these were not systematically analyzed. Utilizing the ratio of means method, we used the change in the apnea-hypopnea index (AHI) as the primary measure of efficacy. Substantial and consistent reductions in the AHI were observed following MMA; adverse events were uncommonly reported. Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.
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                Author and article information

                Contributors
                +31205108894 , l.benoist@erasmusmc.nl
                Journal
                Sleep Breath
                Sleep Breath
                Sleep & Breathing = Schlaf & Atmung
                Springer International Publishing (Cham )
                1520-9512
                1522-1709
                15 September 2017
                15 September 2017
                2018
                : 22
                : 2
                : 441-450
                Affiliations
                [1 ]ISNI 0000000404654431, GRID grid.5650.6, Department of Oral and Maxillofacial Surgery, , Academic Medical Center, ; Amsterdam, The Netherlands
                [2 ]Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Jan Tooropstraat 164 1061 AE, Amsterdam, The Netherlands
                [3 ]ISNI 000000040459992X, GRID grid.5645.2, Departments of Otorhinolaryngology and Head and Neck Surgery, , Erasmus University Medical Center, ; Rotterdam, The Netherlands
                [4 ]ISNI 0000 0001 0295 4797, GRID grid.424087.d, Department of Oral Kinesiology of the Academic Centre for Dentistry Amsterdam (ACTA), ; Amsterdam, The Netherlands
                [5 ]ISNI 0000 0004 0626 3418, GRID grid.411414.5, Departments of Otolaryngology and Head and Neck Surgery, , Antwerp University Hospital, ; Antwerp, Belgium
                Author information
                http://orcid.org/0000-0002-1713-6874
                Article
                1568
                10.1007/s11325-017-1568-4
                5918490
                28913630
                37b14d26-ff31-476b-a8d6-4aef3833f334
                © The Author(s) 2017, corrected publication October/2017

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 10 June 2017
                : 23 August 2017
                : 5 September 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003142, Fonds NutsOhra;
                Award ID: Project 1104-031
                Award Recipient :
                Categories
                Sleep Breathing Physiology and Disorders • Original Article
                Custom metadata
                © Springer International Publishing AG, part of Springer Nature 2018

                Medicine
                obstructive sleep apnea,sleep position,positional therapy,oral appliance therapy,randomized controlled trial

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