Chest
Volume 121, Issue 3, March 2002, Pages 739-746
Journal home page for Chest

Clinical Investigations
Sleep
4-Year Follow-up of Treatment With Dental Appliance or Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea: A Randomized Study

https://doi.org/10.1378/chest.121.3.739Get rights and content

Study objectives

To evaluate the effects of treatment with a dental appliance or uvulopalatopharyngoplasty (UPPP) on somnographic variables in patients with mild-to-moderate obstructive sleep apnea (OSA) followed up for 4 years, and compliance and complementary treatment.

Design

Randomized study.

Setting

Central Hospital, Västerås, Uppsala University, Sweden.

Patients

Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index [AI] > 5 and < 25) were randomized to treatment with a dental appliance or UPPP. Sleep studies were performed before and 1 year and 4 years after intervention. Thirty-two patients in the dental-appliance group and 40 patients in the UPPP group completed the 4-year follow-up.

Results

The success rate (percentage of patients with at least 50% reduction in AI) in the dental-appliance group was 81%, which was significantly higher than in the UPPP group, 53% (p < 0.05). Normalization (AI < 5 or apnea/hypopnea index < 10) was observed in 63% of the dental-appliance group and 33% of the UPPP group after 4 years. The difference between the groups was significant (p < 0.05). The compliance to use of the dental appliance was 62% at the 4-year follow-up. Thirty patients (75%) in the UPPP group continued without complementary treatment. The dental appliances had few adverse effects on the stomatognathic system, and the number of adjustments and repairs of the appliances over time was moderate. Pronounced complaints of nasopharyngeal regurgitation of fluid and difficulty with swallowing after UPPP were reported by 8% and 10%, respectively.

Conclusions

The dental-appliance group showed significantly higher success and normalization rates regarding the somnographic variables compared to the UPPP group, but the effectiveness of the dental appliance was partly invalidated by the compliance of 62% at the 4-year follow-up. However, the appliances had few adverse effects on the stomatognathic system and required only moderate adjustments. Use of a dental appliance with regular follow-up can be recommended for long-term treatment of OSA.

Section snippets

Definitions

Apnea was defined as cessation of respiratory air flow for a minimum of 10 s as measured by a thermistor. Hypopnea was considered to be present when there was a 50% reduction of the air-flow signal recorded by a thermistor combined with a decrease in hemoglobin oxygen saturation of at least 4%. The apnea index (AI) was defined as the average number of apneas per hour of sleep, and the apnea/hypopnea index (AHI) was defined as the average number of apneas plus hypopneas per hour of sleep. The

Results

The mean length of follow-up time measured from the time of randomization was 4.1 years (range, 3.8 to 5.4 years). The baseline values, previously published,23 did not differ significantly between the groups in any of the recorded somnographic variables or in age or BMI.

BMI did not differ between the dental-appliance and UPPP groups at the 1-year and 4-year follow-ups (1-year follow-up, p = 0.223; 4-year follow-up, p = 0.278). There was a significant change in BMI during the course of the study

Discussion

There is general agreement that patients with OSA should have treatment to reduce the frequency of apneas and hypopneas and thus alleviate the subjective disorders. There are also reasons to believe that effective treatment will have positive influence on the prognosis.10, 11

The number of reports of long-term effects of UPPP (after > 1 year) on somnographic variables is limited.12, 13, 14 In these studies, the effects of UPPP were found to be reduced over time. Jansson et al14 found a decrease

Conclusion

In this 4-year follow-up study, the somnographic variables showed a significantly higher success and normalization rate in the dental-appliance group than in the group treated with UPPP. The superior effectiveness of the dental appliance compared to UPPP is partly invalidated by the compliance of 62% in the dental-appliance group. The appliance had few adverse effects on the stomatognathic system; in view of the few adjustments and repairs that were required over time, its construction seems

ACKNOWLEDGMENT

The authors thank Tore Bremer, Kerstin Juhlin, and Laila Olsson for help with the patients in this study.

References (35)

  • K Cheshire et al.

    Factors impairing daytime performance in patients with sleep apnoea/hypopnea syndrome

    Arch Intern Med

    (1992)
  • W Yamadera

    Improvement in excessive daytime sleepiness after surgical treatment or obstructive sleep apnoea syndrome

    Psychiatr Clin Neurosci

    (1995)
  • E Lindberg et al.

    Increased mortality among sleepy snorers: a prospective, population based study

    Thorax

    (1998)
  • Y Peker et al.

    Respiratory disturbance index: an independent predictor of mortality in coronary artery disease

    Am J Respir Crit Care

    (2000)
  • E Svanborg et al.

    Development of nocturnal respiratory disturbance in untreated patients with obstructive sleep apnea syndrome

    Chest

    (1993)
  • M Lysdahl et al.

    Long-term survival after uvulopalatopharyngoplasty in nonobese heavy snorers

    Arch Otolaryngol Head Neck Surg

    (2000)
  • H Larsson

    Long-time follow-up after UPPP for obstructive sleep apnea syndrome

    Acta Otolaryngol (Stockh)

    (1991)
  • Cited by (186)

    • Do Patients Detect Changes in Breathing After Orthognathic Surgery?

      2024, Journal of Oral and Maxillofacial Surgery
    View all citing articles on Scopus

    Supported by a grant from the county of Västmanland.

    View full text