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Hamoda, Mona Mohamed Fathy

University of British Columbia

Background Obstructive Sleep Apnea (OSA) is a highly prevalent chronic condition that requires lifelong treatment with multidisciplinary management. Continuous-Positive-Airway-Pressure (CPAP) is the first-line treatment and Mandibular-Advancement-Splint (MAS) is a leading alternative. This thesis focuses on these two main treatment modalities for OSA and the overall aim of this work is to address some of the knowledge gaps pertaining to these two treatments in adults. The objectives were to characterize the long-term side-effects of MAS and to assess the comparative effectiveness of CPAP and MAS. Objectives also included an assessment of the two forms of CPAP-MAS combination therapy; both treatments used interchangeably or simultaneously. Additionally, this work aimed to compare these two forms of combination to CPAP and MAS monotherapies. Methods This thesis consists of a literature review (chapter 2) and three clinical trials. Trials include a retrospective trial (chapter 3) assessing long term side-effects of MAS, a cross-over randomized trial (chapter 4) comparing the effectiveness of CPAP, MAS and one form of combination (the interchangeable use of CPAP-MAS). Chapter 5 includes a prospective trial comparing CPAP, MAS and the two forms of combination therapy in a subgroup of participants from the randomized cross-over trial. Results CPAP showed higher efficacy, as indicated by the respiratory event index, compared to MAS (p<0.0001) with mean CPAP-MAS difference (95% confidence interval) of 10.4(7.8-13). MAS showed higher adherence with mean±SD of 7.0±1.2 hours/night of use compared to 5.9±1.6 hours/night of CPAP use (p<0.0001). Both showed comparable effects on blood pressure and patient centered outcomes. The two forms of CPAP-MAS combination showed improved adherence relative to CPAP monotherapy in both trials. Long-term dental side-effects of MAS included significant (p<0.001) maxillary incisor retroclination (mean of ≈6˚) and mandibular incisor proclination (mean of ≈8˚) over a mean follow-up period of 12.6 years. Conclusions While CPAP was superior to MAS in efficacy, MAS was superior in adherence however, it was associated with long-term dental side-effects. The combination of both therapies showed increased adherence relative to CPAP monotherapy and provided comparable long-term effectiveness. Combination therapy could be considered as a viable option for the long-term management of OSA.

Text

2025-05-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/81687

Craniofacial Science

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/