Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data

• Published in: Journal of Clinical Sleep Medicine
• Main Authors: Vecchierini, Marie-Françoise, Attali, Valérie, Collet, Jean-Marc, d'Ortho, Marie-Pia, Goutorbe, Frederic, Kerbrat, Jean-Baptiste, Leger, Damien, Lavergne, Florent, Monaca, Christelle, Monteyrol, Pierre-Jean, Mullens, Eric, Pigearias, Bernard, Martin, Francis, Khemliche, Hauria, Lerousseau, Lionel, Meurice, Jean-Claude
• Other Authors: Centre du Sommeil et de la Vigilance Paris, Hôpital Hôtel-Dieu Paris, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Sorbonne Paris Cité (USPC), Neurophysiologie Respiratoire Expérimentale et Clinique (UMRS 1158), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Stomatologie et Chirurgie Maxillo-facial CHU Pitié-Salpêtrière, CHU Pitié-Salpêtrière AP-HP, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de physiologie clinique Paris, Hôpital Lariboisière-Fernand-Widal APHP, Université Paris Cité (UPCité), Maladies neurodéveloppementales et neurovasculaires (NeuroDiderot (UMR_S_1141 / U1141)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), CH Béziers, Hôpital Charles Nicolle Rouen, CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Centre de Diagnostic et de Thérapeutique, Hôpital de l’Hôtel-Dieu Paris, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sommeil-Vigilance-Fatigue et Santé Publique (VIFASOM (URP_7330)), Institut de Recherche Biomédicale des Armées (IRBA)-Université Paris Cité (UPCité), ResMed Science Center, Lille Neurosciences & Cognition - U 1172 (LilNCog), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire Lille (CHRU Lille), Espace Francophone de Pneumologie (EFP), Interactions Arbres-Microorganismes (IAM), Université de Lorraine (UL)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Beijing Forestry University, Centre hospitalier universitaire de Poitiers (CHU Poitiers)
• Format: Article in Journal/Newspaper
• Language: English
• Published: HAL CCSD 2021
• Subjects: obstructive sleep apnea mandibular advancement device apnea-hypopnea index adherence; obstructive sleep apnea; mandibular advancement device; apnea-hypopnea index; adherence; [SDV]Life Sciences [q-bio]; narval
• Online Access: https://hal.science/hal-03995618; https://hal.science/hal-03995618/document; https://hal.science/hal-03995618/file/Orcades%205%20years.pdf; https://doi.org/10.5664/jcsm.9308

International audience Study Objectives: Mandibular advancement devices (MADs) are an alternative to continuous positive airway pressure for the management of obstructive sleep apnea (OSA). The ORthèse d'avanCée mAndibulaire dans le traitement en DEuxi ème intention du SAHOS sév ère (ORCADES) study is investigating the long-term effectiveness of MAD therapy in patients with OSA who refused or were intolerant of continuous positive airway pressure. Five-year follow-up data are presented. Methods: Data were available in 172 of 331 patients treated with a custom-made computer-aided design/computer-aided manufacturing biblock MAD (Narval CC; ResMed, Saint-Priest, France). The primary end point was treatment success (≥50% decrease in apnea-hypopnea index from baseline). Results: Five-year treatment success rates were 52% overall and 25%, 52%, and 63%, respectively, in patients with mild, moderate, or severe OSA. This reflects a decline over time vs 3-6 months (79% overall) and 2 years (68%). Rates declined in all patient subgroups but to the greatest extent in patients with mild OSA. The slight worsening of respiratory parameters over time was not associated with any relevant changes in sleepiness and symptoms. Moderate or severe OSA at baseline, treatment success at 3-6 months, and no previous continuous positive airway pressure use were significant independent predictors of 5-year treatment success on multivariate analysis. No new safety signals emerged during long-term follow-up. The proportion of patients using their MAD for ≥4 h/night on ≥4 days/wk was 93.3%; 91.3% of patients reported device use of ≥6 h/night at 5 years. At 5-year follow-up, 96.5% of patients reported that they wanted to continue MAD therapy. Conclusions: Long-term MAD therapy remained effective after 5 years in >50% of patients, with good levels of patient satisfaction and adherence.