Abstract
Introduction
OSA (Obstructive Sleep Apnea) affects nearly 1 billion people worldwide, carrying risks such as cardiovascular disease, neurological disorders, and motor vehicle accidents. Military populations are disproportionately affected due to frequent travel, stimulant and sedative use, trauma exposure, and chronic sleep deprivation. Although CPAP (continuous positive airway pressure) is the current standard of care, it lacks adherence amongst military members due to poor portability, practical issues, and psychological challenges. This study evaluates accessibility and success of OAT (oral appliance therapy) to assess whether it should be considered first line for military populations.
Methods
Medical records of 213 Tricare-insured patients aged 22-66 prescribed OAT by a private dental sleep medicine practice in the Hampton Roads area were reviewed. Themes of data gathered included severity of OSA, prior CPAP use, pathway/timeline of treatment, and success of OAT. Success was measured both via self-report as well as clinically via changes in AHI.
Results
186 patients initiated treatment, with an average of 10.6 weeks from referral to initiation. 32 patients experienced a delay in care, with 20 reporting a cost barrier. Self-reports demonstrated 129 patients experienced some improvement, compared to 18 denying any improvement. Objective clinical data was limited to 24 patients, with an average improvement/decrease in AHI by 4.7 (p0.01), with a range of -25.2 (improvement) to +4 (worsening), and 8 patients experiencing a decrease of AHI to below 5 (diagnostic threshold).
Conclusion
Overall, OAT is highly effective at improving OSA symptoms and AHI, although for some patients it does not provide complete resolution. Although there are possibilities for delays in care, they were limited to 15% for this study population. The findings of this study prompt the need for further direct comparisons of timeline, cost, and efficacy of the two treatments. In particular, more post-treatment sleep studies are required to determine objective success of OAT relative to CPAP in this population, however, these initial results are promising.