0608 No Adverse Effects from Expiratory Positive Expiratory Pressure (EPAP) Enhanced Mandibular Advancement Device (MAD)

Abstract Introduction The ExVent is an optional accessory to the O2Vent Optima mandibular advancement device (MAD) and provides oral Expiratory Positive Airway Pressure (EPAP). Oral EPAP with the ExVent is designed to provide upper airway support via similar mechanisms of action of nasal EPAP devices in commercial distribution, e.g., passive dilatation of the airway, which reduces flow limitation. Nasal EPAP devices are in commercial distribution as stand-alone therapies for the treatment of OSA. The oral EPAP provided by the ExVent accessory augments the OSA therapy provided by the O2Vent Optima. Long-term complications and adverse effects associated with this combination therapy are not known, but require further study. Methods We conducted a retrospective survey of all patients who received O2Vent Optima mandibular advancement device and oral expiratory positive pressure accessory (ExVent) in Canada and Australia from 2019 to November 2022. A study investigator contacted the participants via telephone, obtained consent and collected data on: demographics, duration of use, frequency of use, complications and adverse events. Results Out of the patient database of 480 subject, 168 (35%) participated. 31 (18%) stopped using the appliance. Out of 137 (81%) subjects, 118 (86%) were still using the ExVent Accessory, 92% medium strength (Yellow). Mean age 52±7 yrs, 76% Male. Mean duration of use 2.7±0.9 years, 91% for most nights, 86% for 6 hours/night. 56% used morning aligner and 74% performed regular jaw exercises. After 4 weeks of use, excessive salivation was occasional (12%), tooth and jaw pain occasional (8%), tooth movement none (0%). Gum /tongue bruises reported in none (0%). TMJ pain/stiffness reported (5%). Change in bite or occlusion leading to discontinuation none (0%), temporary chewing difficulties (24%), dry mouth none (0%). Difficulty with insertion/removal of ExVent valve none (0%), difficulty breathing in none (0%), Malfunctioning/dislodgement of ExVent valve reported in none (0%). Participants reportedly loved their device (94%) and benefited from ExVent (100%). Conclusion This retrospective study demonstrated that majority of patients prescribed EPAP enhanced MAD with O2Vent Optima and ExVent accessory were compliant. There were no significant complications and only minor adverse effects were observed with the combination therapy. Support (if any) Centre for Sleep and Chronobiology, Toronto, ON, Canada