Study objectives: Oral appliance (OA) therapy is the leading alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). It is well tolerated compared to CPAP. However, ≥50% of patients using OA therapy have incomplete resolution of their OSA. Combination therapy with CPAP and oral appliance (CPAP+OA) is a potential alternative for incomplete responders to OA therapy. This study aimed to determine the extent to which combination therapy reduces therapeutic CPAP requirements using gold standard physiological methodology in those who have an incomplete response to OA therapy alone. Methods: 16 incomplete responders (residual AHI> 10events/h) to a novel OA with a built-in oral airway were recruited (3F:13M, aged 31-65 years, BMI: 22-38kg/m², residual AHI range 13-63events/h). Participants were fitted with a nasal mask, pneumotachograph, epiglottic pressure catheter and standard polysomnography equipment. CPAP titrations were performed during NREM supine sleep in each participant during 3 conditions (order randomized): 1) CPAP only, 2) CPAP+OA(oral airway open), and 3) CPAP+OA(oral airway closed). Results: OSA was resolved at pressures of 4±2 and 5±2cmH₂O during CPAP+OA (oral airway open) and CPAP+OA (oral airway closed) conditions versus 8±2cmH₂O during CPAP only (P<0.01). Negative epiglottic pressure swings in oral airway open and closed conditions were normalized to CPAP only levels (-2.5[-3.7,-2.6] vs. -2.3[-3.2,-2.4]vs. -2.1[-2.7,-2.3]cmH₂O). Conclusions: Combined CPAP and OA therapy reduces therapeutic CPAP requirements by 35-45% and minimizes epiglottic pressure swings. This combination may be a therapeutic alternative for patients with incomplete responses to OA therapy alone and those who cannot tolerate high CPAP levels.

中文翻译：

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CPAP结合口服矫治器疗法可降低阻塞性睡眠呼吸暂停患者的CPAP需求和咽压力波动。

研究目标：口服矫治器（OA）治疗是阻塞性睡眠呼吸暂停（OSA）持续气道正压通气（CPAP）的主要替代方法。与CPAP相比，它具有良好的耐受性。但是，≥50％的使用OA治疗的患者的OSA分辨率不完全。CPAP和口服矫治器（CPAP + OA）的联合治疗是对OA治疗反应不完全的潜在替代方法。这项研究旨在确定在仅对OA治疗反应不完全的患者中，使用金标准生理学方法确定联合治疗降低CPAP治疗要求的程度。方法：招募了16名对新型OA并内置口腔气道的不完全反应者（残留AHI> 10events / h）（3F：13M，年龄31-65岁，BMI：22-38kg / m ^2），剩余AHI范围为13-63events / h）。参与者配有鼻罩，气速描记器，会厌压力导管和标准的多导睡眠监测仪。在每位参与者的NREM仰卧睡眠过程中，在3种情况下（随机顺序）进行CPAP滴定：1）仅CPAP，2）CPAP + OA（口腔气道打开），3）CPAP + OA（口腔气道关闭）。结果：在CPAP + OA（口腔气道打开）和CPAP + OA（口腔气道关闭）条件下，OSA在4±2和5±2cmH ₂ O的压力下分辨，而仅在CPAP期间为8±2cmH ₂ O（P <0.01） 。将口腔气道打开和关闭条件下的会厌负压力摆动标准化为仅CPAP水平（-2.5 [-3.7，-2.6] vs.-2.3 [-3.2，-2.4] vs。-2.1 [-2.7，-2.3] cmH ₂O）。结论：CPAP和OA疗法相结合可将CPAP的治疗需求降低35-45％，并使会厌压力波动最小化。对于仅对OA治疗反应不完全的患者和不能耐受高CPAP水平的患者，这种组合可能是一种治疗选择。