Patient's experience of treatment for sleep apnoea with a mandibular advancement splint

Abstract

Background and aims

Obstructive sleep apnoea (OSA) is a well recognised clinical disorder in which there is narrowing and repeated collapse of the upper airway during sleep resulting in the cessation of breathing. Patients with mild to moderate sleep apnoea are often provided with mandibular advancement splint (MAS) therapy as a form of first line or definitive treatment. The aims of this audit were to evaluate patient satisfaction and success of MAS therapy.

Methods

93 patients diagnosed with sleep apnoea and suitable for a splint were recruited prospectively at Queen Victoria Hospital, East Grinstead between January 2009 and October 2010. A patient satisfaction questionnaire was developed by health professionals involved in the care of patients with sleep apnoea and assessed for face and content validity and reliability. Participants completed the questionnaire six weeks after the splint was fitted.

Results

44% who previously experienced snoring now reported no snoring and 47% reported less snoring since wearing the MAS appliance. 69% reported complete resolution of sleep apnoea symptoms. 37% experienced aching teeth and 33% experienced having a dry throat when wearing the appliance. 86% of sleeping partners felt that their quality of sleep was improved following their partners treatment.

Conclusions

The standards set for each criteria in this audit were met. MAS treatment has a key role to play in the management of obstructive sleep apnoea with high rates of patient satisfaction and the majority of patients partners reporting a significant improvement in their own and their partners sleep quality.

Introduction

Obstructive sleep apnoea (OSA) is a well recognised clinical disorder in which there is narrowing and repeated collapse of the upper airway during sleep resulting in the cessation of breathing. The prevalence reported in middle-aged males is 4% and in females 2%.¹ The aetiology behind the collapse of the pharyngeal airway is due to a combination of anatomical and patho-physiological factors. The clinical features include excessive daytime sleepiness, impaired cognitive ability especially during driving, headaches and snoring. The diagnosis Obstructive Sleep Apnoea is based on a full comprehensive history from both the patient and sleeping partner, Epworth sleepiness scale, Mallampati classification, examination of the ear, nose and throat to rule out any physical obstructions, Body Mass Index and an overnight polysomnography. Polysomnography assesses the severity of Obstructive sleep apnoea in terms of Apnoea–Hypopnoea Index (AHI) which is the number of apnoeas or cessation of breathing lasting ten or more seconds per hour. Hypopnoea is measured by 50% reduction in the tidal volume with a 4% or greater fall in the oxygen saturation lasting 10 s or more per hour.

Obstructive sleep apnoea is a multi-factorial condition and therefore management is focused on providing a multi-disciplinary team approach. This team includes an ENT surgeon, Orthodontist, Maxillofacial surgeon and Anaesthetist.

Treatment options include behavioural interventions such as advicing weight loss and reduced alcohol intake, non-surgical options including continuous positive airway pressure (CPAP) and mandibular advancement splint (MAS) therapy, and surgical options.²