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ORCADES: A prospective cohort study of severe obstructive sleep apnoea (OSA) patients receiving second line-treatment with a mandibular repositioning device (MRD)

Jean-Claude Meurice, Valérie Attali, Jean-Marc Collet, Marie-Pia D'Ortho, Jean-Baptiste Kerbrat, Damien Leger, Christelle Monaca, Pierre-Jean Monteyrol, Laurent Morin, Eric Mullens, Bernard Pigearias, Marie-Françoise Vecchierini
European Respiratory Journal 2013 42: P4974; DOI:
Jean-Claude Meurice
1Pneumology, University Hospital of Poitiers, Poitiers, France
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Valérie Attali
2Sleep Disorders Unit, APHP, Pitie-Salpetriere University Hospital, Paris, France
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Jean-Marc Collet
3Stomatology and Maxillo-Facial Surgery, APHP, La Pitie-Salpetriere University Hospital, Paris, France
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Marie-Pia D'Ortho
4Physiology and Functional Explorations, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
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Jean-Baptiste Kerbrat
5Stomatology and Maxillo-Facial Surgery, Charles Nicolle University Hospital, Rouen, France
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Damien Leger
6Sleep and Vigilance Center, APHP, Hôtel Dieu University Hospital, PARIS cedex 4, France
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Christelle Monaca
7Clinical Neurophysiology, Roger Salengro University Hospital, Lille cedex, France
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Pierre-Jean Monteyrol
8Otolaryngology, Polyclinic du Tondu, Bordeaux, France
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Laurent Morin
9ResMed Science Center, ResMed, SAINT PRIEST cedex, France
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Eric Mullens
10Sleep Laboratory, Foundation Bon Sauveur, ALBI cedex, France
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Bernard Pigearias
11Pneumology, Sleep Laboratory, Nice, France
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Marie-Françoise Vecchierini
6Sleep and Vigilance Center, APHP, Hôtel Dieu University Hospital, PARIS cedex 4, France
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Abstract

Background: MRDs are an alternative therapy for OSA especially in pts not treated with continuous positive airway pressure (CPAP).

Aim: ORCADES is a French prospective multicentre observational cohort study providing long-term data (5 years) on 360 OSA pts who refused or did not tolerate CPAP and were treated with a MRD. Results for the first pts treated are shown.

Methods: OSA pts were screened by sleep physicians and referred to a dental specialist who fitted a custom MRD (CadCam; Narval) in eligible pts and did mandibular advancement (MA) titration. Objective sleep data, symptoms, sleep quality, side effects and compliance were evaluated. Treatment success was defined as a ≥50% decrease in apnoea-hypopnoea index (AHI) from baseline.

Results: 232 pts had been treated by 31 Jan 2013 (71% male, age 53.2±11.9 y, 49.8% previously treated with CPAP, mean AHI 29±15/h). AHI was 5-15/h (14%) and 15-30/h (44%) with severe sleepiness or >30/h (42%), 79% of pts were daily snorers and 42% had severe snoring. Final mean MA was 7.3±2.2 mm (75% maximum MA). To date, 143 pts have had a 3-month assessment. Treatment success rate was 84%, regardless of OSA severity or previous CPAP. AHI was <10/h in 85% (-12.6±7.7/h) and 39% (-26.0±12.5/h) of pts with baseline AHI 5-30/h or >30/h, respectively. Frequency and duration of snoring were reduced by 50% (sleep data) and sleep quality improved. Only 10 pts (4%) stopped treatment early for side effects. Compliance was excellent (6.7 h/night, 6.6 days/wk).

Conclusions: CadCam custom MRD is an effective therapy for moderate-to-severe OSA that can be used for pts refusing or noncompliant with CPAP.

  • Sleep disorders
  • Apnoea / Hypopnea
  • © 2013 ERS
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ORCADES: A prospective cohort study of severe obstructive sleep apnoea (OSA) patients receiving second line-treatment with a mandibular repositioning device (MRD)
Jean-Claude Meurice, Valérie Attali, Jean-Marc Collet, Marie-Pia D'Ortho, Jean-Baptiste Kerbrat, Damien Leger, Christelle Monaca, Pierre-Jean Monteyrol, Laurent Morin, Eric Mullens, Bernard Pigearias, Marie-Françoise Vecchierini
European Respiratory Journal Sep 2013, 42 (Suppl 57) P4974;

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ORCADES: A prospective cohort study of severe obstructive sleep apnoea (OSA) patients receiving second line-treatment with a mandibular repositioning device (MRD)
Jean-Claude Meurice, Valérie Attali, Jean-Marc Collet, Marie-Pia D'Ortho, Jean-Baptiste Kerbrat, Damien Leger, Christelle Monaca, Pierre-Jean Monteyrol, Laurent Morin, Eric Mullens, Bernard Pigearias, Marie-Françoise Vecchierini
European Respiratory Journal Sep 2013, 42 (Suppl 57) P4974;
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