Journal des troubles du sommeil et de la thérapie
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Reduced Apnea-Hypopnea Index in Patients with Severe Sleep Apnea Syndrome as Determined by Cervical Collar and Mandibular Advancement Device Combination Therapy

Florim Delijaj, Gustaf Levin, Eva Lindberg and Eugen Wang

Study Objectives: In patients with severe obstructive sleep apnea syndrome (OSAS), continuous positive airway pressure (CPAP) is first-line therapy. Compliance to CPAP is sometimes a problem, and mandibular advancement device (MAD) is then an alternative. However, this alternative is often not effective. It was hypothesized that patients suffering from OSAS would have a freer airway, resulting in a decreased apnea-hypopnea index (AHI), through use of a cervical collar (CC) to extend the neck. To study the effect of this new therapy, a randomized crossover study was conducted to compare MAD monotherapy with CC/MAD combination therapy.

Methods: Eight patients with severe OSAS (AHI>30) who had ceased to use CPAP were enrolled in the randomized crossover study. Four patients started with MAD and four with CC/MAD for one week followed by a wash-out period and then cross-over. Polygraphic sleep recordings were performed at baseline and after each therapy.

Results: The baseline AHI was 51.5 ± 22.5. AHI was reduced to 30.4 ± 23.2 through MAD monotherapy, and to 14.9 ± 10.2 through CC/MAD combination therapy. The effect of the combination therapy was statistically significantly (p=0.018) better than that of the monotherapy. Four patients were achieved an AHI<10/h through use of the combination therapy.

Concusions: The study showed a significant reduction in AHI scores in patients with severe OSAS through use of the CC/MAD combination therapy as compared to the MAD monotherapy. This first report indicates a new possibility for treating severe OSAS in non-compliant CPAP users.