PT  - JOURNAL ARTICLE
AU  - Jean-Claude Meurice
AU  - Valérie Attali
AU  - Jean-Marc Collet
AU  - Marie-Pia D'Ortho
AU  - Jean-Baptiste Kerbrat
AU  - Damien Leger
AU  - Christelle Monaca
AU  - Pierre-Jean Monteyrol
AU  - Laurent Morin
AU  - Eric Mullens
AU  - Bernard Pigearias
AU  - Marie-Françoise Vecchierini
TI  - ORCADES: A prospective cohort study of severe obstructive sleep apnoea (OSA) patients receiving second line-treatment with a mandibular repositioning device (MRD)
DP  - 2013 Sep 01
TA  - European Respiratory Journal
PG  - P4974
VI  - 42
IP  - Suppl 57
4099  - http://erj.ersjournals.com/content/42/Suppl_57/P4974.short
4100  - http://erj.ersjournals.com/content/42/Suppl_57/P4974.full
SO  - Eur Respir J2013 Sep 01; 42
AB  - 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.