Comparing Treatment Effectiveness and Patient-Reported Outcomes of Four Treatment Alternatives for Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a sleep disorder involving apneic and hypopneic episodes, most often related to restrictions in a patient’s airway during sleep. OSA can have significant health consequences, including metabolic and cardiac issues as well as risks associated with chronic hypoxia. Severity of OSA is usually defined by apnea hypopnea index (AHI), which involves the number of apneic and hypopneic events per hour of sleep. While there are multiple therapeutic options for dealing with sleep apnea, there is a lack of research that compares the four most effective treatment methods for moderate to severe OSA—continuous positive airway pressure (CPAP), mandibular advancement device (MAD), upper airway stimulation (UAS), and maxillary mandibular advancement surgery (MMA). The current study assessed retrospective data for 119 patients treated at Thomas Jefferson University Hospital who received one of these therapies. The main outcome variable was Mean Disease Alleviation (MDA), which is a calculated variable based on post-treatment improvement of measures of AHI adjusted by compliance. Secondary outcomes included clinical assessments by polysomnography and patient reported outcome measures (PROMs) completed pre- and post-treatment. The adjusted compliance was also evaluated for each of the therapies to determine its impact on the respective therapies. The four therapies were assessed using ANOVA. The findings from this comparative study indicated that MDA was highest for MMA surgery (M = 36.08, SD = 28.56), when compared to UAS (M = 22.88, SD = 3.16), MAD (M = 6.80, SD = 8.13), and CPAP (M = 5.00, SD =14.80), F (3,115) = 18.95, p < 0.001. Significant predictors of MDA included race (F = 15.57, p < 0.00), BMI (F =5.12, p= 0.026), age (F = 8.84, p= 0.004), hours of sleep (F = 7.524, p= 0.007) and pre-treatment AHI (F = 96.76, p < 0.001). However, additional analyses controlling for these factors demonstrated that the effect of treatment was still significant (F = 11.74, p < 0.001). Ultimately, there was no significant effect of adjusted compliance across the four treatment conditions, and compliance was not a significant predictor of MDA. While each of the PROMs showed significant improvement across all four-treatment conditions, ANOVA analysis showed no significant differences across the four treatment conditions, except for a significant improvement in daytime sleepiness for MMA surgery. These findings were used to construct new treatment recommendations for patients with OSA.
Diecidue, Robert J, "Comparing Treatment Effectiveness and Patient-Reported Outcomes of Four Treatment Alternatives for Obstructive Sleep Apnea" (2021). ETD Collection for Thomas Jefferson University. AAI28414878.