Treatment Effectiveness and Patient-Reported Outcome Measures of Four Treatment Options for OSA

The medical and dental comorbidities of obstructive sleep apnea syndrome (OSAS) are significant and well-documented. The medical community is responsible for providing a gold-standard diagnosis via the polysomnogram. Yet, the question of the management or curative approach and the role of dentistry have been argued.

This study sought to compare the efficacy of four accepted interventions that included two nonsurgical approaches using continuous positive airway pressure, which pneumatically stents the airway open during sleep, and the mandibular advancement device, which mechanically opens the airway by pulling the genioglossus forward, preventing obstruction during sleep. Two surgical interventions were also included for the comparison — an upper airway stimulator and maxillomandibular advancement surgery — which may prevent dependence on an appliance during sleep, perhaps resulting in more of a curative outcome by reducing the apnea–hypopnea index (AHI) to what is considered within normal limits. Interestingly, two of the interventions, both surgical and nonsurgical, were each administered mainly by either a medical or dental provider.

Essential questions in assigning an intervention option are the severity of the disease measured by the AHI and compliance in using a device to manage any airflow limitation. Although the primary outcome measures were quantitatively measured via the change in the AHI, the secondary outcome measures were qualitative and necessary in measuring the clinical correlation, including quality-of-life measures. The authors found that the most significant finding of the study was the statistically significant improvement with both surgical interventions compared with nonsurgical interventions, as measured by the mean disease alleviation, which measures the change in the AHI as well as compliance.

Any sleep intervention must be considered in light of questions regarding patient preferences, risks, economics, long-term prognosis, and residual medical and dental comorbidities. Yet, very little consideration is given to diurnal breathing considerations, which have been well documented and are only improved via maxillomandibular surgery compared with the other three interventions considered in this study.

Lastly, the consideration of only providing a curative approach to patients suffering from the most severe disease ignores the known risk of a predicted future chronic disease with the progressive nature of sleep-disordered breathing and public health implications in the long term. As the authors suggested in their conclusions, “…impact of OSA on daily life might be beneficial in constructing a more useful set of treatment guidelines,” I couldn’t agree more.