Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data

Area of Science:

• Sleep Medicine
• Medical Devices
• Respiratory Disorders

Background:

• Obstructive sleep apnea (OSA) is a common respiratory disorder during sleep.
• Mandibular advancement devices (MADs) offer an alternative to continuous positive airway pressure (CPAP) for OSA management.
• The ORCADES study evaluates the long-term efficacy of MADs in patients intolerant or refusing CPAP.

Purpose of the Study:

• To assess the 5-year effectiveness of MAD therapy for moderate to severe obstructive sleep apnea.
• To identify predictors of long-term treatment success with MADs.
• To evaluate patient adherence and satisfaction with MADs over a 5-year period.

Main Methods:

• The ORCADES study followed 172 patients with OSA treated with custom-made biblock MADs.
• Treatment success was defined as a ≥50% reduction in the apnea-hypopnea index from baseline.
• Multivariate analysis was used to identify predictors of 5-year treatment success.

Main Results:

• Overall 5-year treatment success rate was 52%, declining from earlier time points but remaining significant.
• Success rates varied by OSA severity: 25% (mild), 52% (moderate), and 63% (severe).
• High adherence (≥4h/night, ≥4 days/wk) was reported by 93.3% of patients; 91.3% used the device ≥6h/night at 5 years. No new safety issues emerged.

Conclusions:

• Long-term MAD therapy demonstrates sustained effectiveness in over half of OSA patients after 5 years.
• Patient adherence and desire to continue therapy remained high, supporting MADs as a viable long-term OSA management option.
• Predictors for success included baseline OSA severity, early treatment response, and no prior CPAP use.