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Thesis 3-5-20-Sheets.pdf (800.56 KB)

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A Multi-Factorial Intervention to Increase Adherence to Mandibular Advancement Devices for Obstructive Sleep Apnea: A Randomized Control Trial

Sheets, Victoria P
http://rave.ohiolink.edu/etdc/view?acc_num=osu15833370497103

Abstract Details

2020, Master of Science, Ohio State University, Dentistry.
Objectives: The prevalence of sleep apnea is estimated at approximately 26% and 13% of adult males and females, respectively. That estimated number of adults with sleep apnea is similar to those for diabetes or asthma. Long-term adherence to treatment for chronic conditions in developed countries is estimated at 50%. The air of this study was to test whether a multifactorial intervention increases adherence rates in patients using a titratable oral appliance to treat OSA. Methods: Subjects are between the ages of 18-60+, and have a diagnosis of OSA. After informed consent, subjects are randomly assigned to experimental or control groups. A power analysis indicated group size of 30 subjects each to demonstrate a difference (p<0.05) of +/- 15% between groups with a power of 0.86. The control group receives routine care in addition to objective monitoring with a thermal sensor (DentiTrac®, BRAEBON, Ontario, Canada). This care includes an initial 1-hr consult, then delivery of the oral appliance (with sensor) and follow-up appointments at 1 week, 1 month, 3 months, and 6 months. Experimental subjects receive in addition: educational material at scheduled intervals, Spouse/partner packet, monthly follow up communication, communication with primary physician and dentist about patients, print outs of sensor data, and gift cards for timely follow up with sleep physician. Comparison of adherence is at 1-, 3-, and 6 month time points. Variables looked for the groups are mean nights worn (N > 0), mean nights adherent to prescribed wear time (N > 4), and mean hours worn per night (H/N). Results: Enrollment to date has yielded 90 patients; 39 female and 51 male. A total of 53 have been recorded at 30 days (TP1), of those, 41 have been recorded at 90 days (TP2), and of those 46, 32 have been recorded at 180 days (TP3). Out of the 90 enrolled, 37 patients dropped out for multiple reasons (sensor malfunction - patients continuing to use appliance in the absence of objective monitoring, lost to follow up appointments, patients seeking treatment elsewhere because the clinician was out of network, patient discontinuing use of appliance or using appliance in conjunction with CPAP). There were no significant between group differences for age, sex or BMI (p>0.05) At 30 days post-delivery (TP1), subjects in the experimental group used their oral appliance for more nights (1.5 more nights, p=0.005) and for more nights > 4hrs night (3.3 more nights, p<0.000), than those in the control group. The subjects in the experimental group wore their appliances 5.9 hr nightly vs. 5.2 hr nightly in the control group (p=.258). Conclusions: Data are preliminary as we continue to enroll subjects. Interventions were well received by subjects, and most can be carried out by auxiliary personnel. The experimental interventions resulted in statistically significant improvements in patient adherence to treatment based on the proportion of nights with > 0 hours wear and > 4 hours wear. It remains to be seen if the experimental intervention results in increased adherence compared with standard care over a longer time period.
Allen Firestone, DDS, MS (Advisor)
Ulysses Magalang, MD (Committee Member)
Andy Ni, PhD, MS (Committee Member)
65 p.
Dentistry
Sleep Apnea, OSA, Oral Appliance, Adherence

Recommended Citations

Citations

  • Sheets, V. P. (2020). A Multi-Factorial Intervention to Increase Adherence to Mandibular Advancement Devices for Obstructive Sleep Apnea: A Randomized Control Trial [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu15833370497103

    APA Style (7th edition)

  • Sheets, Victoria. A Multi-Factorial Intervention to Increase Adherence to Mandibular Advancement Devices for Obstructive Sleep Apnea: A Randomized Control Trial. 2020. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu15833370497103.

    MLA Style (8th edition)

  • Sheets, Victoria. "A Multi-Factorial Intervention to Increase Adherence to Mandibular Advancement Devices for Obstructive Sleep Apnea: A Randomized Control Trial." Master's thesis, Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu15833370497103

    Chicago Manual of Style (17th edition)

osu15833370497103
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