Understanding Adherence to Mandibular Advancement Device Therapy for Obstructive Sleep Apnea in Chronic Spinal Cord...

Area of Science:

• Neurology
• Pulmonology
• Medical Devices

Background:

• Obstructive sleep apnea (OSA) is prevalent in individuals with spinal cord injury (SCI).
• Continuous positive airway pressure (CPAP) is the standard OSA treatment, but adherence is often poor in the SCI population.
• Mandibular advancement devices (MADs) present a promising alternative for OSA management in SCI.

Purpose of the Study:

• To evaluate adherence rates to MADs in individuals with SCI.
• To identify common side effects associated with MAD use.
• To explore patient-reported barriers and enablers for MAD usage in SCI.

Main Methods:

• Custom-made MADs were provided to individuals with chronic SCI and moderate-to-severe OSA (AHI ≥15/hour).
• Participants attended follow-up appointments at 1 week, and 1, 3, and 6 months post-treatment initiation.
• Adherence, side effects, and user experiences were assessed via questionnaires and semi-structured interviews.

Main Results:

• Out of 40 participants, 35 completed the study. Adherence was 65% at 1 month and increased to 70% at 6 months.
• Adherent participants showed significantly greater improvements in apnea-hypopnea index (AHI) compared to nonadherent individuals (P = .02).
• Key motivators included reduced fatigue and snoring; temporary side effects did not lead to discontinuation.

Conclusions:

• MADs are an acceptable and well-tolerated treatment for OSA in individuals with SCI.
• Adherence rates for MADs in this population are substantially higher (approximately 3x) than those reported for CPAP.
• Increased access to MADs could improve effective OSA treatment for a greater number of SCI patients.