P031 A Novel Oral Appliance Implementation Protocol Using Nightly Portable Monitoring for OSA Patients Failing CPAP therapy

INTRODUCTION: Oral Appliance Therapy (OAT) is an effective second line treatment for OSA. However, OAT devices do not have active efficacy monitoring, hence little is known about methods to best identify the optimal degree of mandibular advancement. METHODS: Consecutive OSA patients undergoing OAT at a sleep disorders service were recruited to participate in a novel titration protocol using nightly monitoring via a portable device (NightOwl®, Ectosense, Belgium). Demographic & sleep study (PSG) data, and key NightOwl® metrics were collected. A treatment PSG was conducted at conclusion of OAT implementation using identified optimal point of mandibular advancement. RESULTS: 80 subjects were recruited (52 male, 65%) with mean (±SD) age 49±12 years, BMI 28±4.4 kg/m2, Epworth score (ESS) 9.1±4.9. Baseline PSG showed mean AHI 28±20 events/hr, nadir SpO2 84±21%, time SpO2<90% 8.3±30 minutes. Blood pressure monitoring at baseline showed mean day BP 123/70mmHg and night BP 106/57mmHg. The mean mandibular advancement implemented was 2.9±1.7mm. Post treatment mean ESS was 5.1±3.5 (p<0.001). 62/68 (91%) subjects reported perceived benefit on OAT, 49/53 (92%) reduced snoring, 51/62 (82%) improved sleep, 49/62 (79%) increased energy. Treatment PSG on completion of the protocol showed AHI 14±10 events/hr (p<0.001), nadir SpO2 82±33% (p>0.05), time SpO2<90% 1.2±21 minutes (p=0.04). 48/63 (76%) met the AHI definition of OAT success. DISCUSSION: This study demonstrates a novel OAT protocol which led to minimal degree of mandibular advancement, resulting in high rates of symptom benefit and effective treatment of OSA.