RCT: Oral Appliance Therapy and Sleep Position Trainer in Patients With Position Dependant Obstructive Sleep Apnea

NCT02045576 | Completed DMC

• 1 other identifier: POSA
• Study Type: interventional
• Target: 99
• Locations: 1 country
• Sites: 2

Brief Summary

SUMMARY Rationale: Fifty-six percent of patients with Obstructive Sleep Apnea (OSA) are position dependent, defined as having an AHI, which is at least twice as high in supine sleeping position compared to the AHI during sleep in other positions. Standard therapy for patients having mild or moderate POSA is treatment with an Oral Appliance Trainer (OAT). Recently a new device Sleep Position Trainer (SPT) is been introduced especially for patients with POSA. Objective: To compare the effect of positional therapy with the SPT versus OAT on polysomnographic (PSG) parameters, to evaluate the compliance and measuring the possible learning effect that might occur with POSA patients using the SPT for positional therapy over a long term. Study design: Randomised controlled trial Study population: The participants of the research will be recruited from the departments of Otolaryngology and Clinical Neurophysiology, Saint Lucas Andreas Hospital, Amsterdam, the Netherlands. Participants will be males or females older than 18 years with diagnosis of positional OSA. Intervention: The SPT is a sensor positioned in an elastic band attached around the body. The SPT measures the body position and vibrates when the patient lies in supine position. Oral appliance therapy (OAT) is an intra-oral prosthesis, which holds the mandible in a protrusive position. Because of this position more pharyngeal space will be available and the AHI will decrease. After randomisation the first group (n=45) will sleep for a period of 90 +/- 2 days with the SPT every night. The second group (n=45) will also sleep for a period of 90 +/- 2 days only with OAT. After this period the PSG is repeated. Long- term outcome in AHI is measured by repeating the PSG after 1 year. Main study parameters/ endpoints: Primary endpoints; reduction of PSG parameters, in particular AHI, AI, HI, DI, reduction of % of sleeping supine sleep position, without disturbance of the sleep quality. Secondary endpoints: Outcome of Quality of Life questionnaires; EQ-5D, ESS, FOSQ and MFIQ. Compliance and learning effect will also be evaluated for the time period of 3 and 12 months. Finally cardiovascular parameters like blood pressure, pulse rate and BMI/neck circumference will be assessed. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The risks for patients participating in this study are negligible. Inconveniences of the SPT can be discomfort caused by irritation of the band, difficulties with an increased sleeping period on the side or difficulties sleeping with the SPT. This can be compensated by the expected improvement of sleep quality caused by the therapy. Possible side effects of OAT may be discomfort in the jaw, sensitivity of the teeth and a dry mouth. Withdrawing from this therapy means immediate relief of inconveniences.

Conditions

Obstructive Sleep Apnea; Sleep Position Trainer; Oral Appliance Therapy

Keywords

Obstructive Sleep Apnea; sleep position trainer; oral appliance therapy; mandibular advancement device or splint

Outcome Measures

Primary Outcomes (1)

• Efficacy in reducing the mean AHI

  Apnoea Hypopnoea Index (AHI)

  12 months

Secondary Outcomes (4)

• effectiveness in quality of life

  3, 6, 9 and 12 months

• Compliance

  3, 6, 9, 12 months

• Cardiovascular parameters

  3, 6, 9, 12 months

• Cardiovascular parameters

  3, 6, 9 and 12 months

Other Outcomes (2)

• Body Mass Index

  Baseline, 3, 6, 9, 12 months

• Neck circumference

  Baseline, 3, 6, 9, 12 months

Study Arms (2)

Sleep position trainer

EXPERIMENTAL

Nightbalance

Device: sleep position trainer

Oral Appliance Therapy

ACTIVE COMPARATOR

Somnodent

Device: Oral Appliance Therapy

Interventions

sleep position trainer DEVICE

Also known as: Nightbalance

Sleep position trainer

Oral Appliance Therapy DEVICE

Also known as: Somnodent

Oral Appliance Therapy

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years and older.
• Ability to speak, read and write Dutch.
• Ability to follow up.
• Ability to use a computer with internet connection and windows-software for uploading data and online questionnaires.
• Diagnosis with symptomatic mild or moderate OSA (5 \< AHI \< 30).
• Diagnosis of 10 to 90% supine position during the night.
• AHI supine is \>2 times as high as AHI non-supine.
• Expected to maintain current lifestyle (sports, medicine, diet etc.).

You may not qualify if:

• Many dental problems; insufficient teeth for wearing OAT.
• Medication used/ related to sleeping disorders.
• Central Sleep Apnoea Syndrome.
• Night or shifting work.
• Severe chronic heart failure.
• Medical history of known causes of tiredness by day or severe sleep disruption (insomnia, PLMS, Narcolepsy).
• Seizure disorder.
• Known medical history of mental retardation, memory disorders or psychiatric disorders.
• Patients with old type of pacemakers (It is possible that old types of peacemakers are not compatible with the electromagnetic radiation of the electronics of the SPT).
• Shoulder, neck and back complaints.
• Reversible morphological upper airway abnormalities (e.g. enlarged tonsils).
• Inability to provide informed consent.
• Simultaneous use of other treatment modalities to treat OSA.
• Previous treatment for OSA with OAT or SPT
• Pregnancy.

Sponsors & Collaborators

• Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA): lead
• St. Lucas Andreas Ziekenhuis Hospital: collaborator

Study Sites (2)

Academic Medical Center

Amsterdam, Netherlands

Location

St Lucas Andreas Hospital

Amsterdam, Netherlands

Location

Related Publications (2)

• de Ruiter MHT, Benoist LBL, de Vries N, de Lange J. Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial. Sleep Breath. 2018 May;22(2):441-450. doi: 10.1007/s11325-017-1568-4. Epub 2017 Sep 15.

  PMID: 28913630 DERIVED

• Benoist L, de Ruiter M, de Lange J, de Vries N. A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep Med. 2017 Jun;34:109-117. doi: 10.1016/j.sleep.2017.01.024. Epub 2017 Mar 27.

  PMID: 28522078 DERIVED

MeSH Terms

Conditions

Sleep Apnea, Obstructive

Condition Hierarchy (Ancestors)

Sleep Apnea Syndromes; Apnea; Respiration Disorders; Respiratory Tract Diseases; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Nervous System Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Resident/PhD student

Study Record Dates

• First Submitted: November 26, 2013
• First Posted: January 27, 2014
• Study Start: June 1, 2013
• Primary Completion: July 1, 2016
• Study Completion: July 1, 2016
• Last Updated: July 12, 2016

Record last verified: 2016-07

Locations

NL (2)