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Sleep Medicine

(393) Precision Oral Appliance Therapy for the Treatment of Severe OSA

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Edward Sall, MD, DDS, MBA

    Medical Director
    ProSomnus Sleep Technologies and Advanced ENT Physicians of CNY
    Fayetteville , New York, United States

    • Co-Author(s)

  • EM

    Erin Mosca, PhD

    Director, Scientific and Medical Affairs
    ProSomnus Sleep Technologies
    Pleasanton, California, United States

    • Senior Author(s)

  • JR

    John Remmers, MD

    ProSomnus Sleep Technologies, USA

Disclosure(s):
Edward Sall, MD, DDS, MBA: No relevant relationships to disclose.
Erin Mosca, PhD: No relevant relationships to disclose.


Introduction: Mandibular advancing oral appliances (OAs) are commonly used to treat mild and moderate obstructive sleep apnea (OSA) but are less accepted for severe OSA. However, the preference for OAT over CPAP and relative lack of other non-surgical treatment options highlights the need for acceptance of OAT for all severities of OSA.

Methods: Data from two prospective studies conducted for the purpose of validating a test that predicted response to OAT were evaluated. Study participants (n = 109) received a precision OA (ProSomnus Sleep Technologies). Once participants were habituated to OAT, a 2-night type 2 home sleep apnea test was conducted to assess treatment efficaciousness. The mandible was advanced as necessary to lower the respiratory event index (REI).

Results: The study population was as follows: 80 males and 29 females; mean age: 50.2 ± 9.4 years; mean BMI: 31.9 ± 5.0 kg/m2; mean baseline REI: 29.4 ± 19.4 h-1; median Epworth Sleepiness Scale score: 9.1.

A high rate of therapeutic success was achieved, with 62.1%, 79.5%, and 73.2% of participants with mild, moderate, and severe OSA, respectively, achieving a decrease in REI from baseline ≥ 50%. Similarly, 87.2% of moderate and 68.3% of severe patients achieved an REI < 15 h-1. Of those who achieved an REI < 15 h-1, the mean protrusive position of the OA was 81.2 ± 17.4% and 86.4 ± 16.2% for the moderate and severe cohorts, respectively. The time spent at < 90% saturation (T90) and the lowest SpO2 value (LSpO2) did not differ significantly among OSA severities at outcome (p = 0.184 for T90; p = 0.311 for LSpO2).

Conclusions: The OAs used in the studies provided efficacious treatment for most individuals with severe OSA. The lack of difference in T90 and LSpO2 among severities could indicate that disease burden might be alleviated even when event-based indices suggest only moderate improvement. The results indicate that OAT could be a suitable alternative to CPAP for severe OSA and that oxygen-based parameters might provide valuable insight into therapeutic success.