It is clear from the CPAP literature that treatment adherence in OSA patients is often not optimal. In the case of CPAP, this is partly attributable to the obtrusive nature of the treatment. Little work has been carried out to evaluate adherence to oral appliance treatment. A key problem is that there is currently no routinely available procedure for measuring objective use, which may differ considerably from partner or self-reported usage. A number of studies suggest that patients use their oral appliance on most nights and for the majority of the sleeping period, at least in the short-term (12,13,35). The only report in the literature in which objective adherence was measured used a novel intraoral monitoring device: patients used the appliance on an average of 6.8 hours per night (ranging between 5.6 and 7.5 hours) (36), which is similar to the findings of studies that used subjective measures. In the intermediate term (one year) the median use is approximately 77% of nights (19). Long-term adherence, up to five years, also seems to be acceptable amongst selected patients (37). Reasons for stopping treatment include the development of side effects, appliance wear and tear, and attenuation of the efficacy of treatment over time (37). It is likely that adherence is influenced by many factors, including appliance attributes, patient characteristics, and the quality of dental treatment and follow-up procedures. Studies are required to define the relative importance of these and other factors, so that appropriate clinical recommendations aimed at optimizing adherence can be developed. In the only comparison of MAS and TRD treatment adherence to date, Barthlen et al. (38) reported that adherence was superior with MAS (100% vs. 62%).
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