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Patrick J. Strollo, Another Advance in Oral Appliance Therapy?, Sleep, Volume 36, Issue 10, 1 October 2013, Pages 1417–1418, https://doi.org/10.5665/sleep.3024
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Obstructive sleep apnea (OSA) is a common medical problem that is associated with significant morbidity and mortality.1 Continuous positive airway pressure (CPAP) has proven efficacy; however, its effectiveness is impacted by adherence.2 Other treatment options would be helpful. Oral appliance therapy has emerged as a suitable alternative to CPAP, particularly in patients with milder severity of sleep disordered breathing.3 While the utility of CPAP as a treatment option can frequently be determined after one night in the sleep laboratory, a similar paradigm for determining the suitability of oral appliance therapy is currently not part of standard practice. In this issue of SLEEP, Remmers and colleagues provide evidence that a single night titration using a remote controlled mandibular positioner (RCMP) can predict success of oral appliance therapy.4
This report builds on prior work by the authors and others.5–7 The strength of the current study relates to the design of the protocol that was prospective and blinded in nature, with well-defined endpoints to predict success of a mandibular repositioning appliance (MRA) based on the effective target protrusive position (ETPP) determined on the titration night. Of the 67 consecutive participants entered in the protocol, therapeutic success (designated as an apnea hypopnea index [AHI] of < 10 events per hour and a reduction in the AHI ≥ 50% from baseline), was achieved in 87 % of the cohort. A somewhat surprising finding was that on the titration study, the ETPP was quite low, at 68% of the maximal protrusive range. In addition, the titration was accomplished without significant sleep disruption. The cohort that was recruited had clinical features representative of typical patients referred to many sleep centers—predominantly male, middle-aged, with moderate OSA.
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