International Journal of Scientific Research in Dental and Medical Sciences

International Journal of Scientific Research in Dental and Medical Sciences

Factors Influencing Treatment Outcomes and Patient Adherence in Oral Appliance Therapy for Obstructive Sleep Apnea: A Cross-Sectional Study

Document Type : Original Article

Authors
Lazareth Liz Ortiz Santiago 1
Ivette Maria Santiago Lopez 2
1 Department of Stomatology, University of Medical Sciences of Havana, Havana, Cuba
2 Department of Stomatology, Institute of Medical Sciences of Villa Clara, Santa Clara, Cuba
10.30485/ijsrdms.2026.566775.1692
Abstract
Background and aim: Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder associated with substantial cardiovascular, metabolic, and neurocognitive complications. Although Continuous Positive Airway Pressure (CPAP) is considered the gold standard treatment, limited patient adherence has increased interest in Oral Appliance Therapy (OAT) as a more acceptable alternative. This study evaluated treatment outcomes and adherence to OAT and explored factors influencing therapeutic success.
Material and methods: A cross-sectional quantitative study was conducted among adult OSA patients treated with adjustable mandibular advancement devices. Data were collected using structured questionnaires and clinical records, including demographic characteristics, diagnostic methods, appliance type, titration procedures, follow-up frequency, side effects, adherence patterns, and interdisciplinary collaboration between dentists and sleep physicians. Descriptive statistics were used to summarize the findings.
Results: Most participants were middle-aged men diagnosed using polysomnography or home sleep apnea testing. Higher adherence rates (6–7 nights per week) and better clinical outcomes were associated with regular clinician-guided titration, frequent follow-up visits, and effective collaboration between dentists and sleep physicians. These outcomes included reductions in daytime sleepiness, snoring, and the Apnea–Hypopnea Index (AHI). In contrast, unmanaged side effects and irregular follow-up were linked to lower adherence and reduced treatment effectiveness. In addition, administrative and insurance support facilitated timely initiation of therapy and improved long-term use.

Conclusions: OAT is an effective and well-tolerated treatment for patients with mild to moderate OSA. Standardized titration, objective adherence monitoring, regular follow-up, and multidisciplinary care are essential for optimizing treatment outcomes and sustaining long-term adherence.
Keywords
Obstructive Sleep Apnea
Occlusal Splints
Patient Compliance
Treatment Outcome
Subjects
[1] Myśliwiec N, Pniak M, Miklis P, Mawlichanów M, Ciesielska A, Sieradzka A, et al. Diagnosis and treatment of obstructive sleep apnea. Quality in Sport. 2025;37:56951. https://doi.org/10.12775/QS.2025.37.56951.
[2] Aini N, Nguyen TV, Khairi S. Understanding obstructive sleep apnea. J Palembang Nursing Stud. 2024;3:1-4. https://doi.org/10.55048/jpns104.
[3] Ogle OE. Obstructive sleep apnea. Oral and Maxillofacial Surgery, Medicine, and Pathology for the Clinician. 2023:193-200. https://doi.org/10.1002/9781119362579.ch16.
[4] Saint-Fleur AL, Christophides A, Gummalla P, Kier C. Much ado about sleep: current concepts on mechanisms and predisposition to pediatric obstructive sleep apnea. Children. 2021;8(11):1032. https://doi.org/10.3390/children8111032.
[5] Kim, J.-S., & Choi, J. H. Pediatric Obstructive Sleep Apnea: Clinical Manifestations and Consequences. Korean Journal of Otorhinolaryngology-Head and Neck Surgery. 2024;67(10):515–524. https://doi.org/10.3342/kjorl-hns.2024.00374.
[6] Bouloukaki I, Tsiligianni I, Schiza S. Assessment of obstructive sleep apnoea in primary care: Screening and evaluation strategies. International Journal of Clinical Practice. 2020;74(5).
[7] Wozniak DR, Smith I. Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database of Systematic Reviews. 2019(12). https://doi.org/10.1002/14651858.CD003531.pub4.
[8] Rahman Z, Nazim A, Mroke P, Ali K, Allam MP, Mahato A, et al. Long-Term Management of Sleep Apnea-Hypopnea Syndrome: Efficacy and Challenges of Continuous Positive Airway Pressure Therapy: A Narrative Review. Medical Sciences. 2024;13(1):4. https://doi.org/10.3390/medsci13010004.
[9] Kamenova A, Dhunnookchand R, Mann L, Stone IS. P56 CPAP compliance, safety and optimal follow-up; a retrospective analysis. Thorax. 2022;77(Suppl 1):A112.
[10] Paz y Mar H, Castriotta RJ. Duration of positive airway pressure adherence: how much PAP is enough?. Journal of Clinical Sleep Medicine. 2022;18(4):969-70.
[11] Aalaei S, Rezaeitalab F, Tabesh H, Amini M, Afsharisaleh L, Mostafavi SM, et al. Factors affecting patients’ adherence to continuous positive airway pressure therapy for obstructive sleep apnea disorder: a multi-method approach. Iranian Journal of Medical Sciences. 2020;45(3):170-8. https://doi.org/10.30476/ijms.2019.45785.
[12] Mendelson M, Duval J, Bettega F, Tamisier R, Baillieul S, Bailly S, et al. The individual and societal prices of non-adherence to continuous positive airway pressure, contributors, and strategies for improvement. Expert Review of Respiratory Medicine. 2023;17(4):305-17. https://doi.org/10.1080/17476348.2023.2202853.
[13] Maideen NM, Nabi R, Sirajudeen MN, Mohamed AP. Mandibular Advancement Devices’ Efficacy in Treating Obstructive Sleep Apnea-An Overview of Clinical Data. Current Respiratory Medicine Reviews. 2025;21(5):449-58. https://doi.org/10.2174/011573398X367489250610162336.
[14] Ojile J, Uhles M, Alisic S, Postol K, Lillenberg J. Obstructive Sleep Apnea Treatment and the Evaluation of Clinical Effectiveness of Uniquely Designed Oral Appliance Therapy Device. Cureus. 2024;16(5). https://doi.org/10.7759/cureus.59579.
[15] Ou YH, Colpani JT, Cheong CS, Loke W, Thant AT, Shih EC, et al. Mandibular advancement vs CPAP for blood pressure reduction in patients with obstructive sleep apnea. Journal of the American College of Cardiology. 2024;83(18):1760-72. https://doi.org/10.1016/j.jacc.2024.03.359.
[16] Beri A, Pisulkar SG, Dubey SA, Sathe S, Bansod A, Shrivastava A. Appliances therapy in obstructive sleep apnoea: a systematic review and meta-analysis. Cureus. 2023;15(11). https://doi.org/10.7759/cureus.48280.
[17] Kim SJ, Park YG. Mandibular Advancement Device for Elderly OSA Patients. InOrthodontics in Obstructive Sleep Apnea Patients: A Guide to Diagnosis, Treatment Planning, and Interventions 2019;109-130. https://doi.org/10.1007/978-3-030-24413-2_9.
[18] Kang CR, Knowles S, Dekow M. The success of oral appliance therapy based on symptom-driven titration. Military Medicine. 2024;189(3-4):620-6. https://doi.org/10.1093/milmed/usac248.
[19] Funahashi K, Hirose M, Kondo S, Sano Y, Fujita S, Iwata N, et al. Oral appliance therapy for obstructive sleep apnea: a retrospective study in a psychiatric sleep clinic. Fujita Medical Journal. 2023;9(3):218-24. https://doi.org/10.20407/fmj.2022-023.
[20] de Lira AD, Fontenele MK. Relationship between pathological occlusal changes and the signs and symptoms of temporomandibular dysfunction. Turkish journal of orthodontics. 2020;33(4):210-15. https://doi.org/10.5152/TurkJOrthod.2020.20035.
[21] Caples SM, Anderson WM, Calero K, Howell M, Hashmi SD. Use of polysomnography and home sleep apnea tests for the longitudinal management of obstructive sleep apnea in adults: an American Academy of Sleep Medicine clinical guidance statement. Journal of Clinical Sleep Medicine. 2021;17(6):1287-93.
[22] Aldeer M, Javanmard M, Ortiz J, Martin R. Monitoring technologies for quantifying medication adherence. Quantifying Quality of Life: Incorporating Daily Life into Medicine. 2022:49-78. https://doi.org/10.1007/978-3-030-94212-0_3.
[23] Gusiyska A. Advances in Digital Dentistry: Evaluation of Technologies and Their Role in Comprehensive Treatment Planning. International Journal of Science and Research. 2025;14(9):883–892. https://doi.org/10.21275/SR25911154845.
[24] Chu SB, Ooi HS. The digital workflow in dentistry: adoption and challenges. IIUM Journal of Orofacial and Health Sciences. 2025;6(2):244-51. https://doi.org/10.31436/ijohs.v6i2.336.
[25] Christie RH, Abbas A, Koesmahargyo V. Technology for measuring and monitoring treatment compliance remotely. Journal of Parkinson’s disease. 2021;11(s1):S77-81. https://doi.org/10.3233/JPD-212537.
[26] Gimenez L, Druel V, Roques S, Vasseur J, Grosclaude P, Delpierre C, et al. Inventory of tools for care coordination between general practice and hospital system for patients suffering from cancer in active phase of treatment: a scoping review. European Journal of Cancer Care. 2020;29(6):e13319. https://doi.org/10.1111/ecc.13319.
[27] Gibbings R, Wickramasinghe N. Technology's Enabling Role to Improve Care Coordination. InHandbook of Research on Optimizing Healthcare Management Techniques 2020;358-365. https:doi.org/10.4018/978-1-7998-1371-2.ch027.
[28] Hamza A, Giri S, Morgenthaler T. 0605 Temporomandibular and Oral Parafunction as Risk Factors for Jaw Pain Related to Oral Appliance Therapy. Sleep. 2024;47(Supplement_1):A258-9. https://doi.org/10.1093/sleep/zsae067.0604.
[29] Das D, Upadhyay M, Dixit A, Shukla D. Streamlining pediatric dental care through digitization: A short communication. Asian Journal of Oral
 
Health and Allied Sciences. 2025;15(17):1. https://doi.org/10.25259/AJOHAS_16_2025.
[30] Ramseier CA. Diagnostic measures for monitoring and follow‐up in periodontology and implant dentistry. Periodontology 2000. 2024;95(1):129-55. https://doi.org/10.1111/prd.12588.
[31] Genovese P, Giambò P, Abramo F, Mancini M, Pastore M, D’Amico C. Advancements and applications in digital dentistry: a scoping review. InMediterranean Conference on Medical and Biological Engineering and Computing 2023;702-709. https://doi.org/10.1007/978-3-031-49068-2_72.
[32] Cochran WG. Sampling theory when the sampling-units are of unequal sizes. Journal of the American Statistical Association. 1942;37(218):199-212.
[33] Meskill S, Rege R, Kincheloe K, Meskill G. 0511 An observational retrospective study of the efficacy of oral appliance therapy (OAT) in treating obstructive sleep apnea (OSA). Sleep. 2023;46:A226.
[34] Mehta N, Kumar J, Chopra A, Goyal A, Joshi D. Arthroscopic Osteochondral Autograft Transplantation (OAT) in Patients with Focal Osteochondral/Chondral Lesions of the Knee Mid-Term Clinical Outcome. Malaysian orthopaedic journal. 2025;19(2):25. https://doi.org/10.5704/MOJ.2507.004.
International Journal of Scientific Research in Dental and Medical Sciences
Volume 7, Issue 4
Autumn 2025
Pages 140-148

  • Receive Date 04 October 2025
  • Revise Date 21 November 2025
  • Accept Date 02 December 2025
  • Publish Date 01 December 2025