Prevalence of residual excessive sleepiness during effective oral appliance therapy for sleep-disordered breathing

Abstract Background Oral appliance therapy with a mandibular advancement device (OA m ) can yield to complete therapeutic response (apnea–hypopnea index [AHI]  m therapy is unknown. We aimed to determine the prevalence of RES in patients treated with a titratable custom-made duobloc OA m . Methods A prevalence study was performed, collecting data from 185 patients with an established diagnosis of sleep-disordered breathing (SDB) under OA m therapy with a titratable custom-made duobloc device (baseline data were male:female ratio, 129:56; age, 48 ± 9 years; body mass index [BMI], 27 ± 4 kg/m 2 ; Epworth Sleepiness Scale [ESS] score, 10 ± 5; and AHI, 19 ± 12 events/h). A full-night polysomnography was performed at baseline and after 3 months of OA m therapy. Daytime sleepiness was assessed using the ESS with RES defined as an ESS score of 11 or higher out of 24, despite complete therapeutic response. Results Out of 185 patients, 84 patients (45%) showed a complete therapeutic response with an AHI of m therapy. Despite this normalization of AHI, 27 out of these 84 patients (32%) showed RES and had a significantly higher baseline ESS (15 ± 4 vs 9 ± 4; P P  = .028) compared to patients without RES. Conclusion RES under OA m therapy showed a prevalence of up to 32% in SDB patients effectively treated with respect to AHI. Patients with RES were younger and had higher baseline daytime sleepiness.