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A multifactorial intervention to increase adherence to oral appliance therapy with a titratable mandibular advancement device for obstructive sleep apnea: a randomized controlled trial

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
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Abstract

Purpose

Obstructive sleep apnea (OSA) is a common chronic condition, associated with several conditions that account for leading causes of mortality. Adherence to treatment of a chronic condition is, along with treatment efficacy, a major determinant of treatment outcome. The aim of this study was to test whether or not a multifactorial intervention in addition to standard care increases adherence rates in patients using a titratable oral appliance for OSA.

Methods

All subjects were 18 years old or older, had a diagnosis of OSA, and were treated with an oral appliance with an embedded sensor to measure appliance wear time objectively. The control group received routine care, while the experimental subjects received an additional multifactorial intervention. Comparison of adherence was at 30 days (Phase I) and 90 days (Phase II) after appliance delivery.

Results

Data are reported for 82 subjects in Phase I (control 43; experimental 39) and 66 subjects in Phase II (control 36; experimental 30). There were no significant differences for age, sex, body mass index, and apnea-hypopnea index (p > 0.05) between groups. In both Phase I and Phase II, the mean number of nights the appliance was worn 4 or more hours and the mean time the appliance was worn nightly were significantly greater in the experimental than in the control group (p < 0.05).

Conclusions

Interventions were well received by subjects and can be carried out by auxiliary personnel. The experimental interventions resulted in clinically important and statistically significant improvements in patient adherence to treatment.

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Acknowledgements

We thank The Ohio State University Division of Orthodontics and The Ohio State College of Dentistry Dental Faculty Practice for their participation and cooperation.

Funding

This study was funded by the American Sleep Medicine Foundation and the American Academy of Dental Sleep Medicine (175-DR-17). Braebon Medical Corporation donated DentiTrac® sensors and baseplate.

Author information

Authors and Affiliations

  1. Division of Orthodontics, The Ohio State University College of Dentistry, Room 4088, 305 W 12th Ave., Columbus, OH, 43210, USA

    Jie Liu, Ching-Chang Ko & Allen Firestone

  2. Former resident Division of Orthodontics, The Ohio State University College of Dentistry, Private practice, Lexington, KY, USA

    Victoria Sheets

  3. Former resident Division of Orthodontics, The Ohio State University College of Dentistry, Private practice, Reynoldsburg, OH, USA

    Rachel Maerz

  4. Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA

    Ai Ni

  5. Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Ulysses Magalang

Authors
  1. Jie Liu
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  2. Victoria Sheets
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  3. Rachel Maerz
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  4. Ai Ni
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  5. Ulysses Magalang
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  6. Ching-Chang Ko
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  7. Allen Firestone
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Contributions

J. L. contributed to study conceptualization, methodology, investigation, validation, data curation, formal analysis, and writing—original draft, review, and editing. V. S. and R. M. contributed to study concept, design, and data collection. A. N. contributed to study design and statistical analysis. U. M. contributed to study concept and design. C. K. contributed to study concept, design, and writing. A. F. contributed to study conceptualization, methodology, investigation, validation, data curation, formal analysis, writing, project administration, and funding acquisition and supervision.

Corresponding author

Correspondence to Allen Firestone.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Ohio State University Institutional Review Board (IRB number: 2020H0406).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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This paper was submitted in partial fulfillment of the requirements for the degree of Master of Science in the Graduate School of The Ohio State University.

This article is part of the Topical Collection on Oral Appliance Therapy

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Liu, J., Sheets, V., Maerz, R. et al. A multifactorial intervention to increase adherence to oral appliance therapy with a titratable mandibular advancement device for obstructive sleep apnea: a randomized controlled trial. Sleep Breath 26, 1739–1745 (2022). https://doi.org/10.1007/s11325-021-02548-0

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  • DOI: https://doi.org/10.1007/s11325-021-02548-0

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