Adherence to oral appliance treatment for obstructive sleep apnea in patients with continuous positive airway pressure failure

Purpose: The primary aim of this study was to determine the continuation and success rates of oral appliance (OA) therapy for patients in whom continuous positive airway pressure (CPAP) therapy failed. The secondary aim was to identify predictive factors for the long-term use of OA in patients with CPAP failure. Methods: A total of 81 patients who failed with CPAP use were included in this study. Patients who had been using OA for more than 1 year at follow-up visits were assigned to Group S, whereas those who discontinued OA or were lost to follow-up within 1 year were assigned to Group D. We investigated the continuation and success rates of OA therapy, as well as predictive factors for its long-term use for those with CPAP failure. Results: Of the 81 patients, 60 were in Group S and 21 were in Group D; 74.0% of patients with CPAP failure continued OA therapy for more than 1 year. The apnea-hypopnea index was reduced from 41.3 +/- 21.7/h to 12.4 +/- 6.5/h with OA therapy. The only significant predictor of long-term OA use in patients with CPAP failure was awareness of the effectiveness of OA therapy after 1 month ( P = 0.003, odds ratio: 9.731, 95% confidence interval: 2.146-44.119). Conclusions: Patients who recognized the effectiveness of OA treatment in the early stages were more likely to continue using OA therapy long-term.